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Am J Infect Control

Impact of extended use and decontamination with vaporized hydrogen peroxide on N95 respirator fit.

BACKGROUND: To address the shortage of N95 respirators in the wake of the COVID-19 pandemic, some organizations have recommended the decontamination of respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of respirators, which can degrade respirator fit. METHODS: We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times respirators can be decontaminated before respirator fit test failure. The primary outcome was the overall number of cycles required for half of the respirators to fail (either mechanical failure or fit test failure). RESULTS: Thirty-six participants completed 360 hours of respirator usage across 90 cycles. The median number of cycles completed by participants before respirator failure was 2. The overall number of cycles required for half of respirators to fail was 1, 3, 5, and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 respirators, respectively. CONCLUSIONS: The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of respirators must be done cautiously.

covid-19;extended use respirators;filtering face respirators;fit test qualitative;reprocessing;reuse

Journal Article

Lieu, Anthony;Mah, Jordan;Zanichelli, Veronica;Exantus, Rose Carmel;Longtin, Yves

10.1016/j.ajic.2020.08.010

[Title]: Impact of extended use and decontamination with vaporized hydrogen peroxide on N95 respirator fit. [Abstract]: BACKGROUND: To address the shortage of N95 respirators in the wake of the COVID-19 pandemic, some organizations have recommended the decontamination of respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of respirators, which can degrade respirator fit. METHODS: We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times respirators can be decontaminated before respirator fit test failure. The primary outcome was the overall number of cycles required for half of the respirators to fail (either mechanical failure or fit test failure). RESULTS: Thirty-six participants completed 360 hours of respirator usage across 90 cycles. The median number of cycles completed by participants before respirator failure was 2. The overall number of cycles required for half of respirators to fail was 1, 3, 5, and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 respirators, respectively. CONCLUSIONS: The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of respirators must be done cautiously. [Keywords]: covid-19;extended use respirators;filtering face respirators;fit test qualitative;reprocessing;reuse

Curr Opin Crit Care

Core outcomes sets for studies evaluating critical illness and patient recovery.

PURPOSE OF REVIEW: Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers. RECENT FINDINGS: We identified 28 unique COS projects, of which 15 have published results as of May 2020. COS topics relevant to critical care medicine include mechanical ventilation, cardiology, stroke, rehabilitation, and long-term outcomes (LTOs) after critical illness. There are four COS projects for coronavirus disease 2019 (COVID-19), with a 'meta-COS' summarizing common outcomes across these projects. To help facilitate COS development, there are existing resources, standards, guidelines, and tools available from the Core Outcome Measures in Effectiveness Trials Initiative (www.comet-initiative.org/) and the National Institutes of Health-funded Improve LTO project (www.improvelto.com/). SUMMARY: Many COS projects have been completed in critical care, with more on-going COS projects, including foci from across the spectrum of acute critical care, COVID-19, critical care rehabilitation, and patient recovery and LTOs. Extensive resources are accessible to help facilitate rigorous COS development.

Journal Article;Research Support, N.I.H., Extramural;Review

Dinglas, Victor D;Cherukuri, Sai P S;Needham, Dale M

10.1097/MCC.0000000000000750

[Title]: Core outcomes sets for studies evaluating critical illness and patient recovery. [Abstract]: PURPOSE OF REVIEW: Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers. RECENT FINDINGS: We identified 28 unique COS projects, of which 15 have published results as of May 2020. COS topics relevant to critical care medicine include mechanical ventilation, cardiology, stroke, rehabilitation, and long-term outcomes (LTOs) after critical illness. There are four COS projects for coronavirus disease 2019 (COVID-19), with a 'meta-COS' summarizing common outcomes across these projects. To help facilitate COS development, there are existing resources, standards, guidelines, and tools available from the Core Outcome Measures in Effectiveness Trials Initiative (www.comet-initiative.org/) and the National Institutes of Health-funded Improve LTO project (www.improvelto.com/). SUMMARY: Many COS projects have been completed in critical care, with more on-going COS projects, including foci from across the spectrum of acute critical care, COVID-19, critical care rehabilitation, and patient recovery and LTOs. Extensive resources are accessible to help facilitate rigorous COS development. [Keywords]:

EBioMedicine

Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age. METHOD: We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time. FINDINGS: Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5*7 days in mild; 5*9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT. INTERPRETATION: This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19. FUNDING: The project has received funding support from Innovation Fund Denmark.

covid-19;sars-cov-2;systematic review;viral dynamics

Journal Article;Meta-Analysis;Systematic Review

Weiss, Anne;Jellingso, Mads;Sommer, Morten Otto Alexander

10.1016/j.ebiom.2020.102916

[Title]: Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis. [Abstract]: BACKGROUND: The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age. METHOD: We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time. FINDINGS: Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5*7 days in mild; 5*9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT. INTERPRETATION: This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19. FUNDING: The project has received funding support from Innovation Fund Denmark. [Keywords]: covid-19;sars-cov-2;systematic review;viral dynamics

Int J Surg Protoc

CRC COVID: Colorectal cancer services during COVID-19 pandemic. Study protocol for service evaluation.

Introduction: COVID-19 has had an impact on the provision of colorectal cancer care. The aim of the CRC COVID study is to describe the changes in colorectal cancer services in the UK and USA in response to the pandemic and to understand the long-term impact. Methods and analysis: This study comprises 4 phases. Phase 1 is a survey of colorectal units that aims to evaluate adherences and deviations from the best practice guidelines during the COVID-19 pandemic. Phase 2 is a monthly prospective data collection of service provision that aims to determine the impact of the service modifications on the long-term cancer specific outcomes compared to the national standards. Phase 3 aims to predict costs attributable to the modifications of the CRC services and additional resources required to treat patients whose treatment has been affected by the pandemic. Phase 4 aims to compare the impact of COVID-19 on the NHS and USA model of healthcare in terms of service provision and cost, and to propose a standardised model of delivering colorectal cancer services for future outbreaks. Ethics and dissemination: This study is a service evaluation and does not require HRA Approval or Ethical Approval in the UK. Local service evaluation registration is required for each participating centre. In the USA, Ethical Approval was granted by the Research and Development Committee. The results of this study will be disseminated to stakeholders, submitted for peer review publications, conference presentations and circulated via social media. Registration details: Nil.

covid-19;colorectal cancer;guidelines;service evaluation

Journal Article

Courtney, Alona;Howell, Ann-Marie;Daulatzai, Najib;Savva, Nicos;Warren, Oliver;Mills, Sarah;Rasheed, Shahnawaz;Milind, Goel;Tekkis, Nicholas;Gardiner, Matthew;Dai, Tinglong;Safar, Bashar;Efron, Jonathan E;Darzi, Ara;Tekkis, Paris;Kontovounisios, Christos

10.1016/j.isjp.2020.07.005

[Title]: CRC COVID: Colorectal cancer services during COVID-19 pandemic. Study protocol for service evaluation. [Abstract]: Introduction: COVID-19 has had an impact on the provision of colorectal cancer care. The aim of the CRC COVID study is to describe the changes in colorectal cancer services in the UK and USA in response to the pandemic and to understand the long-term impact. Methods and analysis: This study comprises 4 phases. Phase 1 is a survey of colorectal units that aims to evaluate adherences and deviations from the best practice guidelines during the COVID-19 pandemic. Phase 2 is a monthly prospective data collection of service provision that aims to determine the impact of the service modifications on the long-term cancer specific outcomes compared to the national standards. Phase 3 aims to predict costs attributable to the modifications of the CRC services and additional resources required to treat patients whose treatment has been affected by the pandemic. Phase 4 aims to compare the impact of COVID-19 on the NHS and USA model of healthcare in terms of service provision and cost, and to propose a standardised model of delivering colorectal cancer services for future outbreaks. Ethics and dissemination: This study is a service evaluation and does not require HRA Approval or Ethical Approval in the UK. Local service evaluation registration is required for each participating centre. In the USA, Ethical Approval was granted by the Research and Development Committee. The results of this study will be disseminated to stakeholders, submitted for peer review publications, conference presentations and circulated via social media. Registration details: Nil. [Keywords]: covid-19;colorectal cancer;guidelines;service evaluation

Arch Bronconeumol

COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence.

OBJECTIVE: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19. MATERIAL AND METHODS: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model. RESULTS: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress. CONCLUSION: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.

covid-19;meta-analysis;metaanalisis;odds ratio;revision sistematica;smoking;systematic review;tabaquismo

Journal Article;Systematic Review

Jimenez-Ruiz, Carlos A;Lopez-Padilla, Daniel;Alonso-Arroyo, Adolfo;Aleixandre-Benavent, Rafael;Solano-Reina, Segismundo;de Granda-Orive, Jose Ignacio

10.1016/j.arbres.2020.06.024

[Title]: COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence. [Abstract]: OBJECTIVE: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19. MATERIAL AND METHODS: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model. RESULTS: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress. CONCLUSION: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death. [Keywords]: covid-19;meta-analysis;metaanalisis;odds ratio;revision sistematica;smoking;systematic review;tabaquismo

Trials

Impact of Shenfu injection on a composite of organ dysfunction development in critically ill patients with coronavirus disease 2019 (COVID-19): A structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: This study aims to determine the protection provided by Shenfu injection (a traditional Chinese medicine) against development of organ dysfunction in critically ill patients with coronavirus disease 2019 (COVID-19). TRIAL DESIGN: This study is a multicenter, randomized, controlled, open-label, two-arm ratio 1:1, parallel group clinical trial. PARTICIPANTS: The patients, who are aged from 18 to 75 years old, with a confirmed or suspected diagnosis of severe or critical COVID-19, will be consecutively recruited in the study, according to the guideline on diagnosis and treatment of COVID-19 (the 7(th) version) issued by National Health Commission of the People's Republic of China. Exclusion criteria include pregnant and breastfeeding women, atopy or allergies to Shenfu Injection (SFI), severe underlying disease (malignant tumor with multiple metastases, uncontrolled hemopathy, cachexia, severe malnutrition, HIV), active bleeding, obstructive pneumonia caused by lung tumor, severe pulmonary interstitial fibrosis, alveolar proteinosis and allergic alveolitis, continuous use of immunosuppressive drugs in last 6 months, organ transplantation, expected death within 48 hours, the patients considered unsuitable for this study by researchers. The study is conducted in 11 ICUs of designated hospitals for COVID-19, located in 5 cities of China. INTERVENTION AND COMPARATOR: The enrolled patients will randomly receive 100 ml SFI (study group) or identical volume of saline (control group) twice a day for seven consecutive days. Patients in the both groups will be given usual care and the necessary supportive therapies as recommended by the latest edition of the management guidelines for COVID-19 (the 7(th) version so far). MAIN OUTCOMES: The primary endpoint is a composite of newly developed or exacerbated organ dysfunction. This is defined as an increase in the sequential organ failure assessment (SOFA) score of two or more, indicating sepsis and involvement of at least one organ. The SOFA score will be measured for the 14 days after enrolment from the baseline (the score at randomization). The secondary endpoints are shown below: * SOFA score in total * Pneumonia severity index score * Dosage of vasoactive drugs * Ventilation free days within 28 days * Length of stay in intensive care unit * Total hospital costs to treat the patient * 28-day mortality * The incidence of adverse drug events related to SFI RANDOMISATION: The block randomization codes were generated by SAS V.9.1 for allocation of participants in this study. The ratio of random distribution is 1:1. The sealed envelope method is used for allocation concealment. BLINDING (MASKING): The patients and statistical personnel analyzing study data are both blinded. The blinding of group assignment is not adopted for the medical staff. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): This study is expected to recruit 300 patients with COVID-19, (150 in each group). TRIAL STATUS: Protocol version 2.0, February 15, 2020. Patient recruitment started on February 25, and will end on August 31, 2020. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2000030043. Registered February 21, 2020, http://www.chictr.org.cn/showprojen.aspx?proj=49866 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

covid-19;shenfu injection;protocol;randomised controlled trial

Clinical Trial Protocol;Letter;Multicenter Study;Randomized Controlled Trial

Wang, Zong-Yu;Fu, Shou-Zhi;Xu, Liang;Li, Shu-Sheng;Qian, Ke-Jian;He, Xian-Di;Zhu, Guo-Chao;Li, Liang-Hai;Zhang, Jun;Li, Wen-Fang;Qin, Bing-Yu;Zhou, Chen-Liang;Ma, Peng-Lin

10.1186/s13063-020-04677-5

[Title]: Impact of Shenfu injection on a composite of organ dysfunction development in critically ill patients with coronavirus disease 2019 (COVID-19): A structured summary of a study protocol for a randomized controlled trial. [Abstract]: OBJECTIVES: This study aims to determine the protection provided by Shenfu injection (a traditional Chinese medicine) against development of organ dysfunction in critically ill patients with coronavirus disease 2019 (COVID-19). TRIAL DESIGN: This study is a multicenter, randomized, controlled, open-label, two-arm ratio 1:1, parallel group clinical trial. PARTICIPANTS: The patients, who are aged from 18 to 75 years old, with a confirmed or suspected diagnosis of severe or critical COVID-19, will be consecutively recruited in the study, according to the guideline on diagnosis and treatment of COVID-19 (the 7(th) version) issued by National Health Commission of the People's Republic of China. Exclusion criteria include pregnant and breastfeeding women, atopy or allergies to Shenfu Injection (SFI), severe underlying disease (malignant tumor with multiple metastases, uncontrolled hemopathy, cachexia, severe malnutrition, HIV), active bleeding, obstructive pneumonia caused by lung tumor, severe pulmonary interstitial fibrosis, alveolar proteinosis and allergic alveolitis, continuous use of immunosuppressive drugs in last 6 months, organ transplantation, expected death within 48 hours, the patients considered unsuitable for this study by researchers. The study is conducted in 11 ICUs of designated hospitals for COVID-19, located in 5 cities of China. INTERVENTION AND COMPARATOR: The enrolled patients will randomly receive 100 ml SFI (study group) or identical volume of saline (control group) twice a day for seven consecutive days. Patients in the both groups will be given usual care and the necessary supportive therapies as recommended by the latest edition of the management guidelines for COVID-19 (the 7(th) version so far). MAIN OUTCOMES: The primary endpoint is a composite of newly developed or exacerbated organ dysfunction. This is defined as an increase in the sequential organ failure assessment (SOFA) score of two or more, indicating sepsis and involvement of at least one organ. The SOFA score will be measured for the 14 days after enrolment from the baseline (the score at randomization). The secondary endpoints are shown below: * SOFA score in total * Pneumonia severity index score * Dosage of vasoactive drugs * Ventilation free days within 28 days * Length of stay in intensive care unit * Total hospital costs to treat the patient * 28-day mortality * The incidence of adverse drug events related to SFI RANDOMISATION: The block randomization codes were generated by SAS V.9.1 for allocation of participants in this study. The ratio of random distribution is 1:1. The sealed envelope method is used for allocation concealment. BLINDING (MASKING): The patients and statistical personnel analyzing study data are both blinded. The blinding of group assignment is not adopted for the medical staff. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): This study is expected to recruit 300 patients with COVID-19, (150 in each group). TRIAL STATUS: Protocol version 2.0, February 15, 2020. Patient recruitment started on February 25, and will end on August 31, 2020. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2000030043. Registered February 21, 2020, http://www.chictr.org.cn/showprojen.aspx?proj=49866 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol. [Keywords]: covid-19;shenfu injection;protocol;randomised controlled trial

Clin Med (Lond)

Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic.

Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.

covid-19;sars-cov-2;health economics;innovation;testing

Journal Article

Price, Elizabeth;MacPhie, Elizabeth;Kay, Lesley;Lanyon, Peter;Griffiths, Bridget;Holroyd, Christopher;Abhishek, Abhishek;Youngstein, Taryn;Bailey, Kathryn;Clinch, Jacqui;Shaikh, Muddassir;Rivett, Ali

10.7861/clinmed.2020-0160

[Title]: Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic. [Abstract]: Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England. [Keywords]: covid-19;sars-cov-2;health economics;innovation;testing

Microbiol Resour Announc

Genome Sequence of SARS-CoV-2 Isolate Cali-01, from Colombia, Obtained Using Oxford Nanopore MinION Sequencing.

We report the genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolate obtained from a patient with symptoms of coronavirus disease 2019 (COVID-19) who was infected in Cali, Colombia. The patient had no recent travel record and did not require hospitalization. The virus genome was obtained using Oxford Nanopore MinION sequencing.

Journal Article

Lopez-Alvarez, Diana;Parra, Beatriz;Cuellar, Wilmer J

10.1128/MRA.00573-20

[Title]: Genome Sequence of SARS-CoV-2 Isolate Cali-01, from Colombia, Obtained Using Oxford Nanopore MinION Sequencing. [Abstract]: We report the genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolate obtained from a patient with symptoms of coronavirus disease 2019 (COVID-19) who was infected in Cali, Colombia. The patient had no recent travel record and did not require hospitalization. The virus genome was obtained using Oxford Nanopore MinION sequencing. [Keywords]:

Crit Care Explor

Treatment for Severe Coronavirus Disease 2019 With the Seraph-100 Microbind Affinity Blood Filter.

To determine whether Seraph-100 (Exthera Medical Corporation, Martinez, CA) treatment provides clinical benefit for severe coronavirus disease 2019 cases that require mechanical ventilation and vasopressor support. Data Sources: The first two patients in the United States treated with the novel Seraph-100 device. These cases were reviewed by the Food and Drug Administration prior to granting an emergency use authorization for treatment of coronavirus disease 2019. Study Selection: Case series. Data Extraction: Vasopressor dose, mean arterial pressure, temperature, interleukin-6, C-reactive protein, and other biomarker levels were documented both before and after Seraph-100 treatments. Data Synthesis: Vasopressor dose, temperature, interleukin-6, and C-reactive protein levels declined after Seraph-100 treatments. Severe acute respiratory syndrome coronavirus 2 viremia was confirmed in the one patient tested and cleared by the completion of treatments. Conclusions: Seraph-100 use may improve hemodynamic stability in coronavirus disease 2019 cases requiring mechanical ventilation and vasopressor support. These findings warrant future study of a larger cohort with the addition of mortality and total hospital day outcomes.

seraph-100;coronavirus disease 2019;extracorporeal sorbent hemoperfusion;mechanical ventilation;severe acute respiratory syndrome coronavirus 2;vasopressor

Case Reports

Olson, Stephen W;Oliver, James D;Collen, Jacob;Bunin, Jessica;Gleeson, Todd D;Foster, Brian E;Simmons, Mark P;Chen, Hua W;Ficke, Jennifer B;Brown, Tara E;Nau, Mark T;Cebula, Brennan R;Kielstein, Jan;Chung, Kevin K

10.1097/CCE.0000000000000180

[Title]: Treatment for Severe Coronavirus Disease 2019 With the Seraph-100 Microbind Affinity Blood Filter. [Abstract]: To determine whether Seraph-100 (Exthera Medical Corporation, Martinez, CA) treatment provides clinical benefit for severe coronavirus disease 2019 cases that require mechanical ventilation and vasopressor support. Data Sources: The first two patients in the United States treated with the novel Seraph-100 device. These cases were reviewed by the Food and Drug Administration prior to granting an emergency use authorization for treatment of coronavirus disease 2019. Study Selection: Case series. Data Extraction: Vasopressor dose, mean arterial pressure, temperature, interleukin-6, C-reactive protein, and other biomarker levels were documented both before and after Seraph-100 treatments. Data Synthesis: Vasopressor dose, temperature, interleukin-6, and C-reactive protein levels declined after Seraph-100 treatments. Severe acute respiratory syndrome coronavirus 2 viremia was confirmed in the one patient tested and cleared by the completion of treatments. Conclusions: Seraph-100 use may improve hemodynamic stability in coronavirus disease 2019 cases requiring mechanical ventilation and vasopressor support. These findings warrant future study of a larger cohort with the addition of mortality and total hospital day outcomes. [Keywords]: seraph-100;coronavirus disease 2019;extracorporeal sorbent hemoperfusion;mechanical ventilation;severe acute respiratory syndrome coronavirus 2;vasopressor

Diagn Interv Radiol

A review on the use of artificial intelligence for medical imaging of the lungs of patients with coronavirus disease 2019.

The results of research on the use of artificial intelligence (AI) for medical imaging of the lungs of patients with coronavirus disease 2019 (COVID-19) has been published in various forms. In this study, we reviewed the AI for diagnostic imaging of COVID-19 pneumonia. PubMed, arXiv, medRxiv, and Google scholar were used to search for AI studies. There were 15 studies of COVID-19 that used AI for medical imaging. Of these, 11 studies used AI for computed tomography (CT) and 4 used AI for chest radiography. Eight studies presented independent test data, 5 used disclosed data, and 4 disclosed the AI source codes. The number of datasets ranged from 106 to 5941, with sensitivities ranging from 0.67-1.00 and specificities ranging from 0.81-1.00 for prediction of COVID-19 pneumonia. Four studies with independent test datasets showed a breakdown of the data ratio and reported prediction of COVID-19 pneumonia with sensitivity, specificity, and area under the curve (AUC). These 4 studies showed very high sensitivity, specificity, and AUC, in the range of 0.9-0.98, 0.91-0.96, and 0.96-0.99, respectively.

Journal Article;Review

Ito, Rintaro;Iwano, Shingo;Naganawa, Shinji

10.5152/dir.2019.20294

[Title]: A review on the use of artificial intelligence for medical imaging of the lungs of patients with coronavirus disease 2019. [Abstract]: The results of research on the use of artificial intelligence (AI) for medical imaging of the lungs of patients with coronavirus disease 2019 (COVID-19) has been published in various forms. In this study, we reviewed the AI for diagnostic imaging of COVID-19 pneumonia. PubMed, arXiv, medRxiv, and Google scholar were used to search for AI studies. There were 15 studies of COVID-19 that used AI for medical imaging. Of these, 11 studies used AI for computed tomography (CT) and 4 used AI for chest radiography. Eight studies presented independent test data, 5 used disclosed data, and 4 disclosed the AI source codes. The number of datasets ranged from 106 to 5941, with sensitivities ranging from 0.67-1.00 and specificities ranging from 0.81-1.00 for prediction of COVID-19 pneumonia. Four studies with independent test datasets showed a breakdown of the data ratio and reported prediction of COVID-19 pneumonia with sensitivity, specificity, and area under the curve (AUC). These 4 studies showed very high sensitivity, specificity, and AUC, in the range of 0.9-0.98, 0.91-0.96, and 0.96-0.99, respectively. [Keywords]:

Behav Anal Pract

A Proposed Process for Risk Mitigation During the COVID-19 Pandemic.

Recent executive orders have led some applied behavior analysis (ABA) providers to interpret themselves as "essential personnel" during the COVID-19 pandemic. In this article, we argue against a blanket interpretation that being labeled "essential personnel" means that all in-person ABA services for all clients should continue during the COVID-19 pandemic. We believe this argument holds even if ABA providers are not in a jurisdiction currently under an active shelter-at-home or related order. First, we provide a brief description of risks associated with continued in-person ABA service delivery, as well as risks associated with the temporary suspension of services or the transition to remote ABA service delivery. For many clients, continued in-person service delivery carries a significant risk of severe harm to the client, family and caregivers, staff, and a currently overburdened health care system. In these situations, ABA providers should temporarily suspend services or transition to telehealth or other forms of remote service delivery until information from federal, state, and local health care experts deems in-person contact safe. In rare cases, temporary suspension of services or a transition to remote service delivery may place the client or others at risk of significant harm. In these situations, in-person services should likely continue, and ongoing assessment and risk mitigation are essential.

autism;covid-19;decision making;essential services;ethics;pandemic

Journal Article;Review

Cox, David J;Plavnick, Joshua B;Brodhead, Matthew T

10.1007/s40617-020-00430-1

[Title]: A Proposed Process for Risk Mitigation During the COVID-19 Pandemic. [Abstract]: Recent executive orders have led some applied behavior analysis (ABA) providers to interpret themselves as "essential personnel" during the COVID-19 pandemic. In this article, we argue against a blanket interpretation that being labeled "essential personnel" means that all in-person ABA services for all clients should continue during the COVID-19 pandemic. We believe this argument holds even if ABA providers are not in a jurisdiction currently under an active shelter-at-home or related order. First, we provide a brief description of risks associated with continued in-person ABA service delivery, as well as risks associated with the temporary suspension of services or the transition to remote ABA service delivery. For many clients, continued in-person service delivery carries a significant risk of severe harm to the client, family and caregivers, staff, and a currently overburdened health care system. In these situations, ABA providers should temporarily suspend services or transition to telehealth or other forms of remote service delivery until information from federal, state, and local health care experts deems in-person contact safe. In rare cases, temporary suspension of services or a transition to remote service delivery may place the client or others at risk of significant harm. In these situations, in-person services should likely continue, and ongoing assessment and risk mitigation are essential. [Keywords]: autism;covid-19;decision making;essential services;ethics;pandemic

Turk J Med Sci

Epidemiology of COVID-19

It seems that coronaviruses take an important place in the 21th century history. Five of seven human coronavirus was isolated in this century. Unfortunately, last three of them entered our life with a fear of outbreak, pandemic or death. Last human coronavirus which emerged world from Wuhan China, SARS CoV-2 and its clinical expression, Coronavirus disease (COVID-19) recently taken a significant place in our daily practice. Initial reports showed that, its origin was bats. It transmitted human to human by droplet and contact routes, but some doubt about airborne, fecal or intrauterine transmission also should be removed. Its R0 value is 2.3 but it could be as high as 5.7. Its case fatality rate was 6.3, but it was different in different ages and counties, and it could be over 15%. According to early models total 10-12 weeks is required to control an outbreak in the community. While different countries show different daily case numbers, total number of case, case mortality rates or R0, it seems they show a similar epidemic curve. Every day we learn new data about the current outbreak. Since the outbreak is not over yet, every detail should be evaluated carefully and the updates should be followed closely to monitor the epidemiological properties of COVID-19.

covid-19;sars cov-2

Journal Article;Review

Bulut, Cemal;Kato, Yasuyuki

10.3906/sag-2004-172

[Title]: Epidemiology of COVID-19 [Abstract]: It seems that coronaviruses take an important place in the 21th century history. Five of seven human coronavirus was isolated in this century. Unfortunately, last three of them entered our life with a fear of outbreak, pandemic or death. Last human coronavirus which emerged world from Wuhan China, SARS CoV-2 and its clinical expression, Coronavirus disease (COVID-19) recently taken a significant place in our daily practice. Initial reports showed that, its origin was bats. It transmitted human to human by droplet and contact routes, but some doubt about airborne, fecal or intrauterine transmission also should be removed. Its R0 value is 2.3 but it could be as high as 5.7. Its case fatality rate was 6.3, but it was different in different ages and counties, and it could be over 15%. According to early models total 10-12 weeks is required to control an outbreak in the community. While different countries show different daily case numbers, total number of case, case mortality rates or R0, it seems they show a similar epidemic curve. Every day we learn new data about the current outbreak. Since the outbreak is not over yet, every detail should be evaluated carefully and the updates should be followed closely to monitor the epidemiological properties of COVID-19. [Keywords]: covid-19;sars cov-2

Am J Obstet Gynecol

Coronavirus disease 2019 during pregnancy: a systematic review of reported cases.

OBJECTIVE: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019. DATA SOURCES: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible. STUDY ELIGIBILITY CRITERIA: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included. STUDY APPRAISAL AND SYNTHESIS METHODS: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al. RESULTS: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported. CONCLUSION: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.

covid-19;sars-cov-2;cesarean delivery;coronavirus pneumonia;fetal death;neonatal outcomes;preterm birth;stillbirth;vertical transmission novel coronavirus;viral pneumonia

Journal Article;Systematic Review;Video-Audio Media

Della Gatta, Anna Nunzia;Rizzo, Roberta;Pilu, Gianluigi;Simonazzi, Giuliana

10.1016/j.ajog.2020.04.013

[Title]: Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. [Abstract]: OBJECTIVE: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019. DATA SOURCES: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible. STUDY ELIGIBILITY CRITERIA: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included. STUDY APPRAISAL AND SYNTHESIS METHODS: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al. RESULTS: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported. CONCLUSION: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario. [Keywords]: covid-19;sars-cov-2;cesarean delivery;coronavirus pneumonia;fetal death;neonatal outcomes;preterm birth;stillbirth;vertical transmission novel coronavirus;viral pneumonia

Biology (Basel)

Expression Profile of SARS-CoV-2 Host Receptors in Human Pancreatic Islets Revealed Upregulation of ACE2 in Diabetic Donors.

Cellular entry of SARS-CoV-2 is thought to occur through the binding of viral spike S1 protein to ACE2. The entry process involves priming of the S protein by TMPRSS2 and ADAM17, which collectively mediate the binding and promote ACE2 shedding. In this study, microarray and RNA-sequencing (RNA-seq) expression data were utilized to profile the expression pattern of ACE2, ADAM17, and TMPRSS2 in type 2 diabetic (T2D) and non-diabetic human pancreatic islets. Our data show that pancreatic islets express all three receptors irrespective of diabetes status. The expression of ACE2 was significantly increased in diabetic/hyperglycemic islets compared to non-diabetic/normoglycemic. Islets from female donors showed higher ACE2 expression compared to males; the expression of ADAM17 and TMPRSS2 was not affected by gender. The expression of the three receptors was statistically similar in young (</=40 years old) versus old (>/=60 years old) donors. Obese (BMI > 30) donors have significantly higher expression levels of ADAM17 and TMPRSS2 relative to those from non-obese donors (BMI < 25). TMPRSS2 expression correlated positively with HbA1c and negatively with age, while ADAM17 and TMPRSS2 correlated positively with BMI. The expression of the three receptors was statistically similar in muscle and subcutaneous adipose tissues obtained from diabetic and nondiabetic donors. Lastly, ACE2 expression was higher in sorted pancreatic beta-cell relative to other endocrine cells. In conclusion, ACE2 expression is increased in diabetic human islets. More studies are required to investigate whether variations of ACE2 expression could explain the severity of COVID-19 infection-related symptoms between diabetics and non-diabetic patients.

ace2;adam17;covid-19;diabetes;tmprss2;human islets

Journal Article

Taneera, Jalal;El-Huneidi, Waseem;Hamad, Mawieh;Mohammed, Abdul Khader;Elaraby, Esraa;Hachim, Mahmood Yaseen

10.3390/biology9080215

[Title]: Expression Profile of SARS-CoV-2 Host Receptors in Human Pancreatic Islets Revealed Upregulation of ACE2 in Diabetic Donors. [Abstract]: Cellular entry of SARS-CoV-2 is thought to occur through the binding of viral spike S1 protein to ACE2. The entry process involves priming of the S protein by TMPRSS2 and ADAM17, which collectively mediate the binding and promote ACE2 shedding. In this study, microarray and RNA-sequencing (RNA-seq) expression data were utilized to profile the expression pattern of ACE2, ADAM17, and TMPRSS2 in type 2 diabetic (T2D) and non-diabetic human pancreatic islets. Our data show that pancreatic islets express all three receptors irrespective of diabetes status. The expression of ACE2 was significantly increased in diabetic/hyperglycemic islets compared to non-diabetic/normoglycemic. Islets from female donors showed higher ACE2 expression compared to males; the expression of ADAM17 and TMPRSS2 was not affected by gender. The expression of the three receptors was statistically similar in young (</=40 years old) versus old (>/=60 years old) donors. Obese (BMI > 30) donors have significantly higher expression levels of ADAM17 and TMPRSS2 relative to those from non-obese donors (BMI < 25). TMPRSS2 expression correlated positively with HbA1c and negatively with age, while ADAM17 and TMPRSS2 correlated positively with BMI. The expression of the three receptors was statistically similar in muscle and subcutaneous adipose tissues obtained from diabetic and nondiabetic donors. Lastly, ACE2 expression was higher in sorted pancreatic beta-cell relative to other endocrine cells. In conclusion, ACE2 expression is increased in diabetic human islets. More studies are required to investigate whether variations of ACE2 expression could explain the severity of COVID-19 infection-related symptoms between diabetics and non-diabetic patients. [Keywords]: ace2;adam17;covid-19;diabetes;tmprss2;human islets

Postgrad Med J

Experience of video consultation during the COVID-19 pandemic in elderly population for Parkinson's disease and movement disorders.

We have not been prepared for the current pandemic which has hit us hard. COVID-19, being a very contagious disease, one has to be very careful and diligent in caring for our patients keeping safety in mind all the time. For day-to-day care, new norms have been adopted for inpatient care. For outpatient care, the face-to-face (F2F) clinics were cancelled and instead telephone consultations were started. However, it has its own limitations. Unfortunately, there were patients who would need F2F consultation but could not come to the clinic due to the infection risks. For those patients, video consultation was started, which was an innovation in practice. The National Health Service has an Attend Anywhere clinic, as part of transformation in service, which enabled remote consultation with a better outcome than telephone clinics. However, it has its own limitation as not everyone could use it.

geriatric medicine;neurology;parkinson's disease

Journal Article

Kumar, Anil

10.1136/postgradmedj-2020-138846

[Title]: Experience of video consultation during the COVID-19 pandemic in elderly population for Parkinson's disease and movement disorders. [Abstract]: We have not been prepared for the current pandemic which has hit us hard. COVID-19, being a very contagious disease, one has to be very careful and diligent in caring for our patients keeping safety in mind all the time. For day-to-day care, new norms have been adopted for inpatient care. For outpatient care, the face-to-face (F2F) clinics were cancelled and instead telephone consultations were started. However, it has its own limitations. Unfortunately, there were patients who would need F2F consultation but could not come to the clinic due to the infection risks. For those patients, video consultation was started, which was an innovation in practice. The National Health Service has an Attend Anywhere clinic, as part of transformation in service, which enabled remote consultation with a better outcome than telephone clinics. However, it has its own limitation as not everyone could use it. [Keywords]: geriatric medicine;neurology;parkinson's disease

JMIR Public Health Surveill

Delivering Benefits at Speed Through Real-World Repurposing of Off-Patent Drugs: The COVID-19 Pandemic as a Case in Point.

Real-world drug repurposing-the immediate "off-label" prescribing of drugs to address urgent clinical needs-is a widely overlooked opportunity. Off-label prescribing (ie, for a nonapproved indication) is legal in most countries and tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, health crises may mean that real-world repurposing is the only realistic source for solutions. Optimal real-world repurposing requires a track record of safety, affordability, and access for drug candidates. Although thousands of such drugs are already available, there is no central repository of off-label uses to facilitate immediate identification and selection of potentially useful interventions during public health crises. Using the current coronavirus disease (COVID-19) pandemic as an example, we provide a glimpse of the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and targeted toward the underlying pathophysiology that makes COVID-19 so deadly. This paper briefly summarizes why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil citrate are worth considering for patients with COVID-19. Clinical trials to assess efficacy are already underway for famotidine, dipyridamole, and sildenafil, and further trials of all these agents will be important in due course. These examples also reveal the unlimited opportunity to future-proof our health care systems by proactively mining, synthesizing, cataloging, and evaluating the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs.

covid-19;crisis;drug costs;drug repositioning;drugs, generic;off-label use;pandemic;public health;severe acute respiratory syndrome coronavirus 2

Journal Article;Research Support, Non-U.S. Gov't

Rogosnitzky, Moshe;Berkowitz, Esther;Jadad, Alejandro R

10.2196/19199

[Title]: Delivering Benefits at Speed Through Real-World Repurposing of Off-Patent Drugs: The COVID-19 Pandemic as a Case in Point. [Abstract]: Real-world drug repurposing-the immediate "off-label" prescribing of drugs to address urgent clinical needs-is a widely overlooked opportunity. Off-label prescribing (ie, for a nonapproved indication) is legal in most countries and tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, health crises may mean that real-world repurposing is the only realistic source for solutions. Optimal real-world repurposing requires a track record of safety, affordability, and access for drug candidates. Although thousands of such drugs are already available, there is no central repository of off-label uses to facilitate immediate identification and selection of potentially useful interventions during public health crises. Using the current coronavirus disease (COVID-19) pandemic as an example, we provide a glimpse of the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and targeted toward the underlying pathophysiology that makes COVID-19 so deadly. This paper briefly summarizes why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil citrate are worth considering for patients with COVID-19. Clinical trials to assess efficacy are already underway for famotidine, dipyridamole, and sildenafil, and further trials of all these agents will be important in due course. These examples also reveal the unlimited opportunity to future-proof our health care systems by proactively mining, synthesizing, cataloging, and evaluating the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs. [Keywords]: covid-19;crisis;drug costs;drug repositioning;drugs, generic;off-label use;pandemic;public health;severe acute respiratory syndrome coronavirus 2

Int J Clin Pract

SARS-CoV-2 viral spike G614 mutation exhibits higher case fatality rate.

AIM: The COVID-19 pandemic is caused by infection with the SARS-CoV-2 virus. The major mutation detected to date in the SARS-CoV-2 viral envelope spike protein, which is responsible for virus attachment to the host and is also the main target for host antibodies, is a mutation of an aspartate (D) at position 614 found frequently in Chinese strains to a glycine (G). We sought to infer health impact of this mutation. RESULT: Increased case fatality rate correlated strongly with the proportion of viruses bearing G614 on a country by country basis. The amino acid at position 614 occurs at an internal protein interface of the viral spike, and the presence of G at this position was calculated to destabilise a specific conformation of the viral spike, within which the key host receptor binding site is more accessible. CONCLUSION: These results imply that G614 is a more pathogenic strain of SARS-CoV-2, which may influence vaccine design. The prevalence of this form of the virus should also be included in epidemiologic models predicting the COVID-19 health burden and fatality over time in specific regions. Physicians should be aware of this characteristic of the virus to anticipate the clinical course of infection.

Journal Article

Becerra-Flores, Manuel;Cardozo, Timothy

10.1111/ijcp.13525

[Title]: SARS-CoV-2 viral spike G614 mutation exhibits higher case fatality rate. [Abstract]: AIM: The COVID-19 pandemic is caused by infection with the SARS-CoV-2 virus. The major mutation detected to date in the SARS-CoV-2 viral envelope spike protein, which is responsible for virus attachment to the host and is also the main target for host antibodies, is a mutation of an aspartate (D) at position 614 found frequently in Chinese strains to a glycine (G). We sought to infer health impact of this mutation. RESULT: Increased case fatality rate correlated strongly with the proportion of viruses bearing G614 on a country by country basis. The amino acid at position 614 occurs at an internal protein interface of the viral spike, and the presence of G at this position was calculated to destabilise a specific conformation of the viral spike, within which the key host receptor binding site is more accessible. CONCLUSION: These results imply that G614 is a more pathogenic strain of SARS-CoV-2, which may influence vaccine design. The prevalence of this form of the virus should also be included in epidemiologic models predicting the COVID-19 health burden and fatality over time in specific regions. Physicians should be aware of this characteristic of the virus to anticipate the clinical course of infection. [Keywords]:

Clin Biochem

Comparison of serologic and molecular SARS-CoV 2 results in a large cohort in Southern Tuscany demonstrates a role for serologic testing to increase diagnostic sensitivity.

BACKGROUND: Since February 2020, Italian hospitals registered COVID-19 (COronaVIrus Disease 19) cases more often than the rest of the Europe. During this epidemic, health authorities requested swab tests, while seeking new patient paths. METHODS: A dual laboratory approach was evaluated, consisting of patient care reports for viral RNA detection on swabs and rapid serological tests in 516 patients (192 symptomatic or paucisymptomatic and 324 asymptomatic). RESULTS: We found the molecular positive fraction equal to 12% (23/192) among symptomatic/paucisymptomatic (S/P) and 15.4% (50/324) in asymptomatic (As) sets. Among subsets, we observed serologically positive results, corresponding to 35% (8/23) for S/P and 38% (19/50) for As. Among molecular negative cases, we detected specific Immunoglobulin G or M (Ig G or Ig M) positivity in the S/P cohort equal to 6.6% (11/167) and 6% (15/246) in As cases. For indeterminate molecular results, we found S/P serological positivity equal to 100% (1/1) and 54% (13/24) in As patients. We found higher (p < 0.05) seropositivity in older patients (n = 8) among symptomatic and positives for viral RNA (n.23). CONCLUSIONS: It has been observed that a dual approach of serological and molecular tests detects a higher absolute number of disease cases in a pandemic context,which could improve monitoring and health surveillance efficacy. The age-related seropositivity frequency in this study, if confirmed, could enhance the validity of serological tests, especially in older patients.In these subjects, molecular positivity accompanied by serological positivity (distinct for M and G immunoglobulins) should help determine disease status and support decisions related to patient management.

asymptomatic patients;coronavirus disease 19;serological tests;swabs;symptomatic/paucisymptomaticpatients

Comparative Study;Journal Article

Pancrazzi, Alessandro;Magliocca, Pasqualino;Lorubbio, Maria;Vaggelli, Guendalina;Galano, Angelo;Mafucci, Manuela;Duranti, Diletta;Cortesi, Monica;Mazzeschi, Erica;Fabbroni, Sara;Viti, Gianluca;Tartaglia Polcini, Alessandro;Tripodo, Emanuela;Sanchini, Paola;Gervino, Silvana;Tacconi, Danilo;Dei, Simona;Mazzierli, Monica;D'Urso, Antonio;Ognibene, Agostino

10.1016/j.clinbiochem.2020.07.002

[Title]: Comparison of serologic and molecular SARS-CoV 2 results in a large cohort in Southern Tuscany demonstrates a role for serologic testing to increase diagnostic sensitivity. [Abstract]: BACKGROUND: Since February 2020, Italian hospitals registered COVID-19 (COronaVIrus Disease 19) cases more often than the rest of the Europe. During this epidemic, health authorities requested swab tests, while seeking new patient paths. METHODS: A dual laboratory approach was evaluated, consisting of patient care reports for viral RNA detection on swabs and rapid serological tests in 516 patients (192 symptomatic or paucisymptomatic and 324 asymptomatic). RESULTS: We found the molecular positive fraction equal to 12% (23/192) among symptomatic/paucisymptomatic (S/P) and 15.4% (50/324) in asymptomatic (As) sets. Among subsets, we observed serologically positive results, corresponding to 35% (8/23) for S/P and 38% (19/50) for As. Among molecular negative cases, we detected specific Immunoglobulin G or M (Ig G or Ig M) positivity in the S/P cohort equal to 6.6% (11/167) and 6% (15/246) in As cases. For indeterminate molecular results, we found S/P serological positivity equal to 100% (1/1) and 54% (13/24) in As patients. We found higher (p < 0.05) seropositivity in older patients (n = 8) among symptomatic and positives for viral RNA (n.23). CONCLUSIONS: It has been observed that a dual approach of serological and molecular tests detects a higher absolute number of disease cases in a pandemic context,which could improve monitoring and health surveillance efficacy. The age-related seropositivity frequency in this study, if confirmed, could enhance the validity of serological tests, especially in older patients.In these subjects, molecular positivity accompanied by serological positivity (distinct for M and G immunoglobulins) should help determine disease status and support decisions related to patient management. [Keywords]: asymptomatic patients;coronavirus disease 19;serological tests;swabs;symptomatic/paucisymptomaticpatients

Drug Alcohol Rev

The burden of alcohol on health care during COVID-19.

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time.

covid-19;alcohol;healthcare;mortality;policy

Journal Article

Stockwell, Tim;Andreasson, Sven;Cherpitel, Cheryl;Chikritzhs, Tanya;Dangardt, Frida;Holder, Harold;Naimi, Timothy;Sherk, Adam

10.1111/dar.13143

[Title]: The burden of alcohol on health care during COVID-19. [Abstract]: Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time. [Keywords]: covid-19;alcohol;healthcare;mortality;policy

Sci Rep

Nebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in rats.

Ivermectin is a widely used antiparasitic drug with known efficacy against several single-strain RNA viruses. Recent data shows significant reduction of SARS-CoV-2 replication in vitro by ivermectin concentrations not achievable with safe doses orally. Inhaled therapy has been used with success for other antiparasitics. An ethanol-based ivermectin formulation was administered once to 14 rats using a nebulizer capable of delivering particles with alveolar deposition. Rats were randomly assigned into three target dosing groups, lower dose (80-90 mg/kg), higher dose (110-140 mg/kg) or ethanol vehicle only. A toxicology profile including behavioral and weight monitoring, full blood count, biochemistry, necropsy and histological examination of the lungs was conducted. The pharmacokinetic profile of ivermectin in plasma and lungs was determined in all animals. There were no relevant changes in behavior or body weight. There was a delayed elevation in muscle enzymes compatible with rhabdomyolysis, that was also seen in the control group and has been attributed to the ethanol dose which was up to 11 g/kg in some animals. There were no histological anomalies in the lungs of any rat. Male animals received a higher ivermectin dose adjusted by adipose weight and reached higher plasma concentrations than females in the same dosing group (mean Cmax 86.2 ng/ml vs. 26.2 ng/ml in the lower dose group and 152 ng/ml vs. 51.8 ng/ml in the higher dose group). All subjects had detectable ivermectin concentrations in the lungs at seven days post intervention, up to 524.3 ng/g for high-dose male and 27.3 ng/g for low-dose females. nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats, additional experiments are required to assess the safety of this formulation in larger animals.

Journal Article;Research Support, Non-U.S. Gov't

Chaccour, Carlos;Abizanda, Gloria;Irigoyen-Barrio, Angel;Casellas, Aina;Aldaz, Azucena;Martinez-Galan, Fernando;Hammann, Felix;Gil, Ana Gloria

10.1038/s41598-020-74084-y

[Title]: Nebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in rats. [Abstract]: Ivermectin is a widely used antiparasitic drug with known efficacy against several single-strain RNA viruses. Recent data shows significant reduction of SARS-CoV-2 replication in vitro by ivermectin concentrations not achievable with safe doses orally. Inhaled therapy has been used with success for other antiparasitics. An ethanol-based ivermectin formulation was administered once to 14 rats using a nebulizer capable of delivering particles with alveolar deposition. Rats were randomly assigned into three target dosing groups, lower dose (80-90 mg/kg), higher dose (110-140 mg/kg) or ethanol vehicle only. A toxicology profile including behavioral and weight monitoring, full blood count, biochemistry, necropsy and histological examination of the lungs was conducted. The pharmacokinetic profile of ivermectin in plasma and lungs was determined in all animals. There were no relevant changes in behavior or body weight. There was a delayed elevation in muscle enzymes compatible with rhabdomyolysis, that was also seen in the control group and has been attributed to the ethanol dose which was up to 11 g/kg in some animals. There were no histological anomalies in the lungs of any rat. Male animals received a higher ivermectin dose adjusted by adipose weight and reached higher plasma concentrations than females in the same dosing group (mean Cmax 86.2 ng/ml vs. 26.2 ng/ml in the lower dose group and 152 ng/ml vs. 51.8 ng/ml in the higher dose group). All subjects had detectable ivermectin concentrations in the lungs at seven days post intervention, up to 524.3 ng/g for high-dose male and 27.3 ng/g for low-dose females. nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats, additional experiments are required to assess the safety of this formulation in larger animals. [Keywords]:

Curr Med Res Pract

Knowledge, perception, and practices towards COVID-19 pandemic among general public of India: A cross-sectional online survey.

Background: The success of battle against COVID-19 depends on public adherence towards infection control measures, which is greatly affected by their knowledge, perception, and practices towards this infection. Aim: To assess the knowledge, perception, and practice towards COVID-19 among the general public of India. Materials and methods: A cross-sectional, online survey was performed among Indian residents who were aged above 15 years. A pre-validated online questionnaire on COVID-19 was distributed through various messenger groups and social media in the author's network. The questionnaire comprised of four sections to collect data regarding demographics, knowledge, perception, and practices towards COVID-19 pandemic. Multiple linear regression analysis was used to correlate demographics with knowledge, perception and practice scores about COVID-19. Results: A total of 2459 participants (Males = 1424; Females = 1035) completed the survey tool. The mean age of the study participants was 24.5 +/- 7.2. The main sources for COVID-19 information were television (74.5%) and social media (71.0%). Majority of the respondents shown a correct rate of knowledge (74.7%), perception (57.6%), and practices (88.1%) towards COVID-19. Respondents aged more than 40 years; higher education level, living in urban areas, and pursuing healthcare profession were positively associated with high knowledge, perception, and practices scores towards COVID-19. Conclusion: The study concludes, majority of the respondents shown a good knowledge and right practices towards COVID-19 pandemic, still there was a gap in right perception towards underlying myths and facts about COVID-19. Providing educational programs and circulating WHO myth busters through media or social networks can resolve underlying misconceptions about COVID-19 and improves the knowledge, perception, and practices among public.

covid-19;knowledge;perception;practice;public;sars-cov-2

Journal Article

Narayana, Goruntla;Pradeepkumar, Bhupalam;Ramaiah, Jinka Dasaratha;Jayasree, Thummala;Yadav, Dasari Laluprasad;Kumar, Bonala Kranthi

10.1016/j.cmrp.2020.07.013

[Title]: Knowledge, perception, and practices towards COVID-19 pandemic among general public of India: A cross-sectional online survey. [Abstract]: Background: The success of battle against COVID-19 depends on public adherence towards infection control measures, which is greatly affected by their knowledge, perception, and practices towards this infection. Aim: To assess the knowledge, perception, and practice towards COVID-19 among the general public of India. Materials and methods: A cross-sectional, online survey was performed among Indian residents who were aged above 15 years. A pre-validated online questionnaire on COVID-19 was distributed through various messenger groups and social media in the author's network. The questionnaire comprised of four sections to collect data regarding demographics, knowledge, perception, and practices towards COVID-19 pandemic. Multiple linear regression analysis was used to correlate demographics with knowledge, perception and practice scores about COVID-19. Results: A total of 2459 participants (Males = 1424; Females = 1035) completed the survey tool. The mean age of the study participants was 24.5 +/- 7.2. The main sources for COVID-19 information were television (74.5%) and social media (71.0%). Majority of the respondents shown a correct rate of knowledge (74.7%), perception (57.6%), and practices (88.1%) towards COVID-19. Respondents aged more than 40 years; higher education level, living in urban areas, and pursuing healthcare profession were positively associated with high knowledge, perception, and practices scores towards COVID-19. Conclusion: The study concludes, majority of the respondents shown a good knowledge and right practices towards COVID-19 pandemic, still there was a gap in right perception towards underlying myths and facts about COVID-19. Providing educational programs and circulating WHO myth busters through media or social networks can resolve underlying misconceptions about COVID-19 and improves the knowledge, perception, and practices among public. [Keywords]: covid-19;knowledge;perception;practice;public;sars-cov-2

Eur Arch Otorhinolaryngol

Anosmia: an evolution of our understanding of its importance in COVID-19 and what questions remain to be answered.

BACKGROUND: From the start of the pandemic, many European otolaryngologists observed an unprecendented number of anosmic patients. Early reports proposed that anosmia could be the first or even the only symptom of COVID-19 infection, prompting calls for self-isolation in affected patients. METHODS: In the present article, we review the COVID-19 anosmia literature and try to answer the following two questions: first, why is COVID-19 infection responsible for such a high incidence of anosmia? Second, in patients with more severe forms is anosmia really less prevalent and why? RESULTS: In terms of the etiology of olfactory dysfunction, several hypotheses were proposed at the outset of the pandemic; that olfactory cleft inflammation and obstruction caused a localized conductive loss, that there was injury to the sustentacular supporting cells in the olfactory epithelium or, given the known neurotropic potential of coronavirus, that the virus could invade and damage the olfactory bulb. Olfactory cleft obstruction may contribute to the olfactory dysfunction in some patients, perhaps most likely in those that show very early resolution, it cannot account for the loss in all patients. Moreover, disordered regrowth and a predominance of immature neurons have been shown to be associated with parosmia, which is a common finding amongst patients with Covid-related anosmia. A central mechanism therefore certainly seems to be consistent with the group of patients with more prolonged olfactory deficits. Sustentacular cells showing ACE-2 immunohistochemical expression 200 to 700 times greater than nasal or tracheal epithelia seem to be the main SARS-CoV-2 gateway. As the pathophysiology of COVID-19 anosmia seems to be better understood, the question of why patients with a moderate to severe form of COVID-19 infection have less olfactory involvement remains unresolved. Different potential explanations are discussed in this review. CONCLUSIONS: The last 5 months have benefited from great international collaborative research, first highlighting and then proving the value of loss of smell and taste as a symptom of COVID-19. Adoption of loss of smell into the case definition by international public health bodies will facilitate control of disease transmission.

anosmia;covid-19;coronavirus;olfactory;smell

Journal Article;Review

Saussez, Sven;Lechien, Jerome R;Hopkins, Claire

10.1007/s00405-020-06285-0

[Title]: Anosmia: an evolution of our understanding of its importance in COVID-19 and what questions remain to be answered. [Abstract]: BACKGROUND: From the start of the pandemic, many European otolaryngologists observed an unprecendented number of anosmic patients. Early reports proposed that anosmia could be the first or even the only symptom of COVID-19 infection, prompting calls for self-isolation in affected patients. METHODS: In the present article, we review the COVID-19 anosmia literature and try to answer the following two questions: first, why is COVID-19 infection responsible for such a high incidence of anosmia? Second, in patients with more severe forms is anosmia really less prevalent and why? RESULTS: In terms of the etiology of olfactory dysfunction, several hypotheses were proposed at the outset of the pandemic; that olfactory cleft inflammation and obstruction caused a localized conductive loss, that there was injury to the sustentacular supporting cells in the olfactory epithelium or, given the known neurotropic potential of coronavirus, that the virus could invade and damage the olfactory bulb. Olfactory cleft obstruction may contribute to the olfactory dysfunction in some patients, perhaps most likely in those that show very early resolution, it cannot account for the loss in all patients. Moreover, disordered regrowth and a predominance of immature neurons have been shown to be associated with parosmia, which is a common finding amongst patients with Covid-related anosmia. A central mechanism therefore certainly seems to be consistent with the group of patients with more prolonged olfactory deficits. Sustentacular cells showing ACE-2 immunohistochemical expression 200 to 700 times greater than nasal or tracheal epithelia seem to be the main SARS-CoV-2 gateway. As the pathophysiology of COVID-19 anosmia seems to be better understood, the question of why patients with a moderate to severe form of COVID-19 infection have less olfactory involvement remains unresolved. Different potential explanations are discussed in this review. CONCLUSIONS: The last 5 months have benefited from great international collaborative research, first highlighting and then proving the value of loss of smell and taste as a symptom of COVID-19. Adoption of loss of smell into the case definition by international public health bodies will facilitate control of disease transmission. [Keywords]: anosmia;covid-19;coronavirus;olfactory;smell

Expert Rev Anti Infect Ther

Tocilizumab for patients with severe COVID-19: a retrospective, multi-center study.

BACKGROUND: Tocilizumab, an inhibitor of the interleukin-6 receptor, may decrease the inflammatory response and control the symptoms of severe coronavirus disease 2019 (COVID-19), but the evidence is scarce. METHODS: This retrospective study included patients with severe COVID-19 requiring oxygen therapy who received tocilizumab in seven centers across Poland. We assessed on-treatment changes in clinical status and inflammatory markers. RESULTS: Twenty-eight patients were included (19 male), with a mean age of 61.7 +/- 12.4 years. The mean time from symptom onset to the first tocilizumab dose was 10.5 +/- 5.7 days. Clinical status improved within 24 hours in 11 (39%) patients, within one week in 23 (82%) patients, and within two weeks in 25 (89%); one (4%) patient showed no change and two (7%) patients died. Sixteen patients (57%) no longer needed oxygen therapy within a week (p < 0.001). The serum concentrations of C-reactive protein, procalcitonin, and fibrinogen decreased significantly (p </= 0.001). Lung changes improved in 21 (84%) patients within two weeks of treatment; 19 had minimal or no changes upon final examination. CONCLUSIONS: Tocilizumab can control the symptoms of severe COVID-19 by reducing the inflammatory response and rapidly improves the clinical status in most patients.

covid-19;sars-cov-2;interleukin-6;therapy;tocilizumab

Journal Article;Multicenter Study;Research Support, Non-U.S. Gov't

Tomasiewicz, Krzysztof;Piekarska, Anna;Stempkowska-Rejek, Justyna;Serafinska, Sylwia;Gawkowska, Aleksandra;Parczewski, Milosz;Niscigorska-Olsen, Jolanta;Lapinski, Tadeusz W;Zarebska-Michaluk, Dorota;Kowalska, Justyna D;Horban, Andrzej;Flisiak, Robert

10.1080/14787210.2020.1800453

[Title]: Tocilizumab for patients with severe COVID-19: a retrospective, multi-center study. [Abstract]: BACKGROUND: Tocilizumab, an inhibitor of the interleukin-6 receptor, may decrease the inflammatory response and control the symptoms of severe coronavirus disease 2019 (COVID-19), but the evidence is scarce. METHODS: This retrospective study included patients with severe COVID-19 requiring oxygen therapy who received tocilizumab in seven centers across Poland. We assessed on-treatment changes in clinical status and inflammatory markers. RESULTS: Twenty-eight patients were included (19 male), with a mean age of 61.7 +/- 12.4 years. The mean time from symptom onset to the first tocilizumab dose was 10.5 +/- 5.7 days. Clinical status improved within 24 hours in 11 (39%) patients, within one week in 23 (82%) patients, and within two weeks in 25 (89%); one (4%) patient showed no change and two (7%) patients died. Sixteen patients (57%) no longer needed oxygen therapy within a week (p < 0.001). The serum concentrations of C-reactive protein, procalcitonin, and fibrinogen decreased significantly (p </= 0.001). Lung changes improved in 21 (84%) patients within two weeks of treatment; 19 had minimal or no changes upon final examination. CONCLUSIONS: Tocilizumab can control the symptoms of severe COVID-19 by reducing the inflammatory response and rapidly improves the clinical status in most patients. [Keywords]: covid-19;sars-cov-2;interleukin-6;therapy;tocilizumab

Am Surg

Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has expanded the utilization of telemedicine in clinical practice to minimize potential risks to both patients and providers. We aim to describe the perception of telemedicine by both surgical patients and providers to understand the preferences for future incorporation in future surgical practice. METHODS: An anonymous survey was administered to providers that transitioned clinic visits to telemedicine encounters since the start of the COVID-19 pandemic. In the second part of the study, patients who underwent video telemedicine appointments answered survey questions via telephone. RESULTS: Twenty-six out of 36 (72.7%) providers responded. Over 75% reported that they could effectively communicate with patients over telemedicine. Six (23.1%) reported that they could adequately assess surgical sites. Of 361 patients, 187 consented to the study (consent rate 51.8%). Among patients, the most common result to choose a telemedicine appointment was to avoid the risk of COVID-19 transmission (84, 44.9%), though the minority reported that they would choose telemedicine after the pandemic (64, 34.2%). Those patients who would choose an in-person visit were more likely to have a higher Charlson Comorbidity Score, body mass index, and use friends or family for transportation. In open-ended feedback, patients suggested that telemedicine would be better suited for long-term follow-up rather than the immediate postoperative setting. CONCLUSIONS: Patients and providers reported a high degree of satisfaction using telemedicine during the COVID-19 pandemic but noted concern with limited physical examinations. Telemedicine may be suited for preoperative evaluation and medium-term and long-term postoperative follow-up for surgical patients.

general surgery;social and electronic media;special topics;surgical quality

Journal Article

Zhu, Clara;Williamson, John;Lin, Andrew;Bush, Kathryn;Hakim, Abraham;Upadhyaya, Kirtan;Hunter, Krystal;Sensenig, Richard;Spitz, Francis;Atabek, Umur;Hong, Young Ki

10.1177/0003134820945196

[Title]: Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences. [Abstract]: INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has expanded the utilization of telemedicine in clinical practice to minimize potential risks to both patients and providers. We aim to describe the perception of telemedicine by both surgical patients and providers to understand the preferences for future incorporation in future surgical practice. METHODS: An anonymous survey was administered to providers that transitioned clinic visits to telemedicine encounters since the start of the COVID-19 pandemic. In the second part of the study, patients who underwent video telemedicine appointments answered survey questions via telephone. RESULTS: Twenty-six out of 36 (72.7%) providers responded. Over 75% reported that they could effectively communicate with patients over telemedicine. Six (23.1%) reported that they could adequately assess surgical sites. Of 361 patients, 187 consented to the study (consent rate 51.8%). Among patients, the most common result to choose a telemedicine appointment was to avoid the risk of COVID-19 transmission (84, 44.9%), though the minority reported that they would choose telemedicine after the pandemic (64, 34.2%). Those patients who would choose an in-person visit were more likely to have a higher Charlson Comorbidity Score, body mass index, and use friends or family for transportation. In open-ended feedback, patients suggested that telemedicine would be better suited for long-term follow-up rather than the immediate postoperative setting. CONCLUSIONS: Patients and providers reported a high degree of satisfaction using telemedicine during the COVID-19 pandemic but noted concern with limited physical examinations. Telemedicine may be suited for preoperative evaluation and medium-term and long-term postoperative follow-up for surgical patients. [Keywords]: general surgery;social and electronic media;special topics;surgical quality

SAGE Open Med

Neurological manifestations in COVID-19: A narrative review.

COVID-19, a respiratory viral infection, has affected more than 10 million individuals worldwide. Common symptoms include fever, dry cough, fatigue and shortness of breath. Some patients show neurological manifestations such as headache, dizziness, cerebrovascular disease, peripheral nerve and muscle symptoms and smell and taste impairment. In previous studies, SARS-CoV-1 and MERS-CoV were found to affect the nervous system. Given the high similarity between SARS-CoV-1 and SARS-CoV-2, effects on the nervous system by SARS-CoV-2 are a possibility. We have outlined the common neurological manifestations in COVID-19 (information are up-to-date as of June 2020) and discussed the possible pathogenetic mechanisms and management options.

covid-19;guillain-barre syndrome;sars-cov-2;cerebrovascular disease;neurological manifestations;taste and smell impairments

Journal Article;Review

Rahman, Asma;Niloofa, Roshan;De Zoysa, Ishan M;Cooray, Akila D;Kariyawasam, Jayani;Seneviratne, Suranjith L

10.1177/2050312120957925

[Title]: Neurological manifestations in COVID-19: A narrative review. [Abstract]: COVID-19, a respiratory viral infection, has affected more than 10 million individuals worldwide. Common symptoms include fever, dry cough, fatigue and shortness of breath. Some patients show neurological manifestations such as headache, dizziness, cerebrovascular disease, peripheral nerve and muscle symptoms and smell and taste impairment. In previous studies, SARS-CoV-1 and MERS-CoV were found to affect the nervous system. Given the high similarity between SARS-CoV-1 and SARS-CoV-2, effects on the nervous system by SARS-CoV-2 are a possibility. We have outlined the common neurological manifestations in COVID-19 (information are up-to-date as of June 2020) and discussed the possible pathogenetic mechanisms and management options. [Keywords]: covid-19;guillain-barre syndrome;sars-cov-2;cerebrovascular disease;neurological manifestations;taste and smell impairments

Patient Educ Couns

Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan.

OBJECTIVE: Behavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown. METHODS: Participants (n = 1,980) were randomly assigned to five intervention messages (from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area) and a control message. Intention to stay at home before and after reading messages was assessed. A one-way ANOVA with Tukey's or Games-Howell test was conducted. RESULTS: Compared with other messages, the message from a physician significantly increased participants' intention to stay at home in areas with high numbers of people infected (versus a governor, p = .002; an expert, p = .023; a resident, p = .004). CONCLUSION: The message from a physician-which conveyed the crisis of overwhelmed hospitals and consequent risk of people being unable to receive treatment-increased the intent to stay at home the most. PRACTICE IMPLICATIONS: Health professionals and media operatives may be able to encourage people to stay at home by disseminating the physicians' messages through media and the internet.

covid-19;health communication;novel coronavirus;persuasion;protection motivation theory;social lockdown

Journal Article

Okuhara, Tsuyoshi;Okada, Hiroko;Kiuchi, Takahiro

10.1016/j.pec.2020.08.016

[Title]: Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan. [Abstract]: OBJECTIVE: Behavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown. METHODS: Participants (n = 1,980) were randomly assigned to five intervention messages (from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area) and a control message. Intention to stay at home before and after reading messages was assessed. A one-way ANOVA with Tukey's or Games-Howell test was conducted. RESULTS: Compared with other messages, the message from a physician significantly increased participants' intention to stay at home in areas with high numbers of people infected (versus a governor, p = .002; an expert, p = .023; a resident, p = .004). CONCLUSION: The message from a physician-which conveyed the crisis of overwhelmed hospitals and consequent risk of people being unable to receive treatment-increased the intent to stay at home the most. PRACTICE IMPLICATIONS: Health professionals and media operatives may be able to encourage people to stay at home by disseminating the physicians' messages through media and the internet. [Keywords]: covid-19;health communication;novel coronavirus;persuasion;protection motivation theory;social lockdown

Int J Infect Dis

Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was characterized at the end of 2019, and soon spread around the world, generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women. OBJECTIVE: The aim of this systematic literature review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity, and disease outcomes. A SRL was performed in PubMed and Embase, searching terms corresponding to the 'PEO' format: population = adult patients affected with COVID-19; exposure = gender; outcome = any available clinical outcomes by gender, including mortality and disease severity. The search covered the period from January 1 to April 30, 2020. Exclusion criteria were: case reports/series, reviews, commentaries, languages other than English. Full-text, original articles were included. Data on study type, country, and patients' characteristics were extracted. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). From a total of 950 hits generated by the database search, 85 articles fulfilling the inclusion criteria were selected. RESULTS: A random-effects meta-analysis was performed to compare mortality, recovery rates, and disease severity in men compared with women. The male to female ratio for cases was 1:0.9. A significant association was found between male sex and mortality (OR = 1.81; 95% CI 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI 0.55-0.95). Male patients were more likely to present with a severe form of COVID-19 (OR = 1.46; 95% CI 1.10-1.94). CONCLUSIONS: Males are slightly more susceptible to SARS-CoV2 infection, present with a more severe disease, and have a worse prognosis. Further studies are warranted to unravel the biological mechanisms underlying these observations.

covid-19;gender;meta-analysis;systematic review

Journal Article;Meta-Analysis;Systematic Review

Ortolan, Augusta;Lorenzin, Mariagrazia;Felicetti, Mara;Doria, Andrea;Ramonda, Roberta

10.1016/j.ijid.2020.07.076

[Title]: Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis. [Abstract]: BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was characterized at the end of 2019, and soon spread around the world, generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women. OBJECTIVE: The aim of this systematic literature review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity, and disease outcomes. A SRL was performed in PubMed and Embase, searching terms corresponding to the 'PEO' format: population = adult patients affected with COVID-19; exposure = gender; outcome = any available clinical outcomes by gender, including mortality and disease severity. The search covered the period from January 1 to April 30, 2020. Exclusion criteria were: case reports/series, reviews, commentaries, languages other than English. Full-text, original articles were included. Data on study type, country, and patients' characteristics were extracted. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). From a total of 950 hits generated by the database search, 85 articles fulfilling the inclusion criteria were selected. RESULTS: A random-effects meta-analysis was performed to compare mortality, recovery rates, and disease severity in men compared with women. The male to female ratio for cases was 1:0.9. A significant association was found between male sex and mortality (OR = 1.81; 95% CI 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI 0.55-0.95). Male patients were more likely to present with a severe form of COVID-19 (OR = 1.46; 95% CI 1.10-1.94). CONCLUSIONS: Males are slightly more susceptible to SARS-CoV2 infection, present with a more severe disease, and have a worse prognosis. Further studies are warranted to unravel the biological mechanisms underlying these observations. [Keywords]: covid-19;gender;meta-analysis;systematic review

Zhonghua Jie He He Hu Xi Za Zhi

[Clinical characteristics and outcome of 64 patients with severe COVID-19].

Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. chi(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) mug/L, which was significantly higher than that in the survival group (0.02, 0.03) mug/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) mug/L, which was higher than 33.1 (25.7, 54.5) mug/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.

covid-19;myocardial injury;prognosis;respiratory distress syndrome, adult;viral myocarditis

Journal Article

Zhu, Q;Zhang, W;Wang, Q;Liu, J H;Wu, C H;Luo, T;Peng, P

10.3760/cma.j.cn112147-20200308-00275

[Title]: [Clinical characteristics and outcome of 64 patients with severe COVID-19]. [Abstract]: Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. chi(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) mug/L, which was significantly higher than that in the survival group (0.02, 0.03) mug/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) mug/L, which was higher than 33.1 (25.7, 54.5) mug/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19. [Keywords]: covid-19;myocardial injury;prognosis;respiratory distress syndrome, adult;viral myocarditis

Tohoku J Exp Med

Coronavirus Disease 2019: Hematological Anomalies and Antithrombotic Therapy.

After the first cases of COVID-19 appeared in Wuhan, China at the end of 2019, the disease quickly become a pandemic that has seriously affected the economic and health systems in more than 200 countries and territories around the world. Although most patients have mild symptoms or are even asymptomatic, there are patients who can develop serious complications such as acute respiratory distress syndrome or venous thromboembolism requiring mechanical ventilation and intensive care. Hence, it is important to identify patients with a higher risk of complications in a timely manner. Thus, the objective of this paper is to review the hematological laboratory parameters that consistently are altered in COVID-19 and to identify their relationship with the severity of the disease. According to 11 selected reports, the frequency of patients aged > 65 years is higher among subjects severely affected or deceased; likewise, males predominantly suffer from comorbidities such as hypertension, diabetes or obesity. Retrospective studies have identified alterations in various hematological and inflammatory parameters as part of the host's response to infection and a secondary increased risk of different thrombotic events. Among these altered parameters, D-dimer, C-reactive protein, and interleukin-6 have been tested as prognostic biomarkers due to their close relationship with the severity of the disease. Actually, they can reliably indicate the use of antithrombotic therapy at prophylactic or therapeutic doses (mainly D-dimer), as has already been established in those patients who, after an individualized assessment, appear to be at high risk for thrombotic events.

covid-19;antithrombotic therapy;biomarkers;hematological anomalies;thrombo-inflammation

Journal Article;Review

Ornelas-Ricardo, Diana;Jaloma-Cruz, Ana Rebeca

10.1620/tjem.251.327

[Title]: Coronavirus Disease 2019: Hematological Anomalies and Antithrombotic Therapy. [Abstract]: After the first cases of COVID-19 appeared in Wuhan, China at the end of 2019, the disease quickly become a pandemic that has seriously affected the economic and health systems in more than 200 countries and territories around the world. Although most patients have mild symptoms or are even asymptomatic, there are patients who can develop serious complications such as acute respiratory distress syndrome or venous thromboembolism requiring mechanical ventilation and intensive care. Hence, it is important to identify patients with a higher risk of complications in a timely manner. Thus, the objective of this paper is to review the hematological laboratory parameters that consistently are altered in COVID-19 and to identify their relationship with the severity of the disease. According to 11 selected reports, the frequency of patients aged > 65 years is higher among subjects severely affected or deceased; likewise, males predominantly suffer from comorbidities such as hypertension, diabetes or obesity. Retrospective studies have identified alterations in various hematological and inflammatory parameters as part of the host's response to infection and a secondary increased risk of different thrombotic events. Among these altered parameters, D-dimer, C-reactive protein, and interleukin-6 have been tested as prognostic biomarkers due to their close relationship with the severity of the disease. Actually, they can reliably indicate the use of antithrombotic therapy at prophylactic or therapeutic doses (mainly D-dimer), as has already been established in those patients who, after an individualized assessment, appear to be at high risk for thrombotic events. [Keywords]: covid-19;antithrombotic therapy;biomarkers;hematological anomalies;thrombo-inflammation

Medicine (Baltimore)

Efficacy of integrative Traditional Chinese and Western medicine for the treatment of patients infected with 2019 novel coronavirus (COVID-19): A protocol for systematic review and meta analysis.

BACKGROUND: No specific anti-virus drugs or vaccines have been available for the treatment of COVID-19. Integrative traditional Chinese and western medicine has been proposed as a therapeutic option with substantial applications in China. This protocol is proposed for a systematic review and meta-analysis that aims to evaluate the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19. METHODS: Ten databases including PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang database, China Biomedical Literature Database (CBM) and Chinese Biomedical Literature Service System (SinoMed) will be searched. All published randomized controlled trials, clinical controlled trials, case-control, and case series that meet the pre-specified eligibility criteria will be included. Primary outcome measures include mortality, clinical recovery rate, duration of fever, progression rate from mild or moderate to severe, improvement of symptoms, biomarkers of laboratory examination and changes in computed tomography. Secondary outcomes include dosage of hormonotherapy, incidence and severity of adverse events and quality of life. Study selection, data extraction and assessment of bias risk will be conducted by 2 reviewers independently. RevMan software (V.5.3.5) will be used to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of evidence will be assessed by the GRADE system. RESULTS: This study will provide a well-reported and high-quality synthesis on the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19. CONCLUSION: This systematic review protocol will be helpful for providing evidence of whether integrative traditional Chinese and western medicine treatment is an effective therapeutic approach for patients with COVID-19. ETHICS AND DISSEMINATION: Ethical approval is unnecessary as no individual patient or privacy data is collected. The results of this study will be disseminated in a peer-reviewed scientific journal and/or conference presentation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020167205.

Journal Article;Meta-Analysis;Systematic Review

Liu, Dan;You, Yanyan;Chen, Yunhui;Tang, Songqi

10.1097/MD.0000000000020781

[Title]: Efficacy of integrative Traditional Chinese and Western medicine for the treatment of patients infected with 2019 novel coronavirus (COVID-19): A protocol for systematic review and meta analysis. [Abstract]: BACKGROUND: No specific anti-virus drugs or vaccines have been available for the treatment of COVID-19. Integrative traditional Chinese and western medicine has been proposed as a therapeutic option with substantial applications in China. This protocol is proposed for a systematic review and meta-analysis that aims to evaluate the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19. METHODS: Ten databases including PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang database, China Biomedical Literature Database (CBM) and Chinese Biomedical Literature Service System (SinoMed) will be searched. All published randomized controlled trials, clinical controlled trials, case-control, and case series that meet the pre-specified eligibility criteria will be included. Primary outcome measures include mortality, clinical recovery rate, duration of fever, progression rate from mild or moderate to severe, improvement of symptoms, biomarkers of laboratory examination and changes in computed tomography. Secondary outcomes include dosage of hormonotherapy, incidence and severity of adverse events and quality of life. Study selection, data extraction and assessment of bias risk will be conducted by 2 reviewers independently. RevMan software (V.5.3.5) will be used to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of evidence will be assessed by the GRADE system. RESULTS: This study will provide a well-reported and high-quality synthesis on the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19. CONCLUSION: This systematic review protocol will be helpful for providing evidence of whether integrative traditional Chinese and western medicine treatment is an effective therapeutic approach for patients with COVID-19. ETHICS AND DISSEMINATION: Ethical approval is unnecessary as no individual patient or privacy data is collected. The results of this study will be disseminated in a peer-reviewed scientific journal and/or conference presentation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020167205. [Keywords]:

Sci Transl Med

3C-like protease inhibitors block coronavirus replication in vitro and improve survival in MERS-CoV-infected mice.

Pathogenic coronaviruses are a major threat to global public health, as exemplified by severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the newly emerged SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19). We describe herein the structure-guided optimization of a series of inhibitors of the coronavirus 3C-like protease (3CLpro), an enzyme essential for viral replication. The optimized compounds were effective against several human coronaviruses including MERS-CoV, SARS-CoV, and SARS-CoV-2 in an enzyme assay and in cell-based assays using Huh-7 and Vero E6 cell lines. Two selected compounds showed antiviral effects against SARS-CoV-2 in cultured primary human airway epithelial cells. In a mouse model of MERS-CoV infection, administration of a lead compound 1 day after virus infection increased survival from 0 to 100% and reduced lung viral titers and lung histopathology. These results suggest that this series of compounds has the potential to be developed further as antiviral drugs against human coronaviruses.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't;Research Support, U.S. Gov't, Non-P.H.S.

Rathnayake, Athri D;Zheng, Jian;Kim, Yunjeong;Perera, Krishani Dinali;Mackin, Samantha;Meyerholz, David K;Kashipathy, Maithri M;Battaile, Kevin P;Lovell, Scott;Perlman, Stanley;Groutas, William C;Chang, Kyeong-Ok

10.1126/scitranslmed.abc5332

[Title]: 3C-like protease inhibitors block coronavirus replication in vitro and improve survival in MERS-CoV-infected mice. [Abstract]: Pathogenic coronaviruses are a major threat to global public health, as exemplified by severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the newly emerged SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19). We describe herein the structure-guided optimization of a series of inhibitors of the coronavirus 3C-like protease (3CLpro), an enzyme essential for viral replication. The optimized compounds were effective against several human coronaviruses including MERS-CoV, SARS-CoV, and SARS-CoV-2 in an enzyme assay and in cell-based assays using Huh-7 and Vero E6 cell lines. Two selected compounds showed antiviral effects against SARS-CoV-2 in cultured primary human airway epithelial cells. In a mouse model of MERS-CoV infection, administration of a lead compound 1 day after virus infection increased survival from 0 to 100% and reduced lung viral titers and lung histopathology. These results suggest that this series of compounds has the potential to be developed further as antiviral drugs against human coronaviruses. [Keywords]:

Pathogens

Molecular Aspects of COVID-19 Differential Pathogenesis.

In the absence of therapeutic interventions, and a possible vaccine candidate, the spread of COVID-19 disease and associated fatalities are on the rise. The high mutation frequency in the genomic material of these viruses supports their ability to adapt to new environments, resulting in an efficient alteration in tissue tropism and host range. Therefore, the coronavirus' health threats could be relevant for the long-term. The epidemiological data indicate that age, sex, and cardio-metabolic disease have a significant impact on the spread and severity of COVID-19. In this review, we highlight recent updates on the pathogenesis of SARS-CoV-2 among men and women, including children. We also discuss the role of the cellular receptors and coreceptors used by the virus to enter host cells on differential infection among men, women, and cardio-metabolic patients.

covid-19;sars-cov-2;cardio-metabolic disease;comorbidity;differential pathogenesis

Journal Article;Review

Rothan, Hussin A;Acharya, Arpan;Reid, St Patrick;Kumar, Mukesh;Byrareddy, Siddappa N

10.3390/pathogens9070538

[Title]: Molecular Aspects of COVID-19 Differential Pathogenesis. [Abstract]: In the absence of therapeutic interventions, and a possible vaccine candidate, the spread of COVID-19 disease and associated fatalities are on the rise. The high mutation frequency in the genomic material of these viruses supports their ability to adapt to new environments, resulting in an efficient alteration in tissue tropism and host range. Therefore, the coronavirus' health threats could be relevant for the long-term. The epidemiological data indicate that age, sex, and cardio-metabolic disease have a significant impact on the spread and severity of COVID-19. In this review, we highlight recent updates on the pathogenesis of SARS-CoV-2 among men and women, including children. We also discuss the role of the cellular receptors and coreceptors used by the virus to enter host cells on differential infection among men, women, and cardio-metabolic patients. [Keywords]: covid-19;sars-cov-2;cardio-metabolic disease;comorbidity;differential pathogenesis

Int J Forecast

Comparing the accuracy of several network-based COVID-19 prediction algorithms.

Researchers from various scientific disciplines have attempted to forecast the spread of the Coronavirus Disease 2019 (COVID-19). The proposed epidemic prediction methods range from basic curve fitting methods and traffic interaction models to machine-learning approaches. If we combine all these approaches, we obtain the Network Inference-based Prediction Algorithm (NIPA). In this paper, we analyse a diverse set of COVID-19 forecast algorithms, including several modifications of NIPA. Among the diverse set of algorithms that we evaluated, original NIPA performs best on forecasting the spread of COVID-19 in Hubei, China and in the Netherlands. In particular, we show that network-based forecasting is superior to any other forecasting algorithm.

bayesian methods;epidemiology;forecast accuracy;machine learning methods;network inference;sir model;time series methods

Journal Article

Achterberg, Massimo A;Prasse, Bastian;Ma, Long;Trajanovski, Stojan;Kitsak, Maksim;Van Mieghem, Piet

10.1016/j.ijforecast.2020.10.001

[Title]: Comparing the accuracy of several network-based COVID-19 prediction algorithms. [Abstract]: Researchers from various scientific disciplines have attempted to forecast the spread of the Coronavirus Disease 2019 (COVID-19). The proposed epidemic prediction methods range from basic curve fitting methods and traffic interaction models to machine-learning approaches. If we combine all these approaches, we obtain the Network Inference-based Prediction Algorithm (NIPA). In this paper, we analyse a diverse set of COVID-19 forecast algorithms, including several modifications of NIPA. Among the diverse set of algorithms that we evaluated, original NIPA performs best on forecasting the spread of COVID-19 in Hubei, China and in the Netherlands. In particular, we show that network-based forecasting is superior to any other forecasting algorithm. [Keywords]: bayesian methods;epidemiology;forecast accuracy;machine learning methods;network inference;sir model;time series methods

J Child Neurol

COVID-19: A Review for the Pediatric Neurologist.

Children are susceptible to infection with the novel coronavirus SARS-CoV-2. In this time of uncertainty, this review attempts to compile information that may be helpful to pediatric neurologists. This review consolidates current data on the disease associated with SARS-CoV-2, called COVID-19, and information from past coronavirus epidemics, to discuss diseases of pediatric neurology including Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculoneuropathy); central demyelinating diseases like multiple sclerosis and acute disseminated encephalomyelitis; infantile spasms; febrile seizures; and maternal-fetal transmission of virus.

covid-19;coronavirus;infectious disease;pediatric

Journal Article;Review

Christy, Alison

10.1177/0883073820939387

[Title]: COVID-19: A Review for the Pediatric Neurologist. [Abstract]: Children are susceptible to infection with the novel coronavirus SARS-CoV-2. In this time of uncertainty, this review attempts to compile information that may be helpful to pediatric neurologists. This review consolidates current data on the disease associated with SARS-CoV-2, called COVID-19, and information from past coronavirus epidemics, to discuss diseases of pediatric neurology including Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculoneuropathy); central demyelinating diseases like multiple sclerosis and acute disseminated encephalomyelitis; infantile spasms; febrile seizures; and maternal-fetal transmission of virus. [Keywords]: covid-19;coronavirus;infectious disease;pediatric

PLoS One

The Global Health Security Index is not predictive of coronavirus pandemic responses among Organization for Economic Cooperation and Development countries.

The ongoing COVID-19 pandemic has devastated many countries with ripple effects felt in various sectors of the global economy. In November 2019, the Global Health Security (GHS) Index was released as the first detailed assessment and benchmarking of 195 countries to prevent, detect, and respond to infectious disease threats. This paper presents the first comparison of Organization for Economic Cooperation and Development OECD countries' performance during the pandemic, with the pre-COVID-19 pandemic preparedness as determined by the GHS Index. Using a rank-based analysis, four indices were compared between select countries, including total cases, total deaths, recovery rate, and total tests performed, all standardized for comparison. Our findings suggest a discrepancy between the GHS index rating and the actual performance of countries during this pandemic, with an overestimation of the preparedness of some countries scoring highly on the GHS index and underestimation of the preparedness of other countries with relatively lower scores on the GHS index.

Journal Article;Research Support, N.I.H., Extramural

Abbey, Enoch J;Khalifa, Banda A A;Oduwole, Modupe O;Ayeh, Samuel K;Nudotor, Richard D;Salia, Emmanuella L;Lasisi, Oluwatobi;Bennett, Seth;Yusuf, Hasiya E;Agwu, Allison L;Karakousis, Petros C

10.1371/journal.pone.0239398

[Title]: The Global Health Security Index is not predictive of coronavirus pandemic responses among Organization for Economic Cooperation and Development countries. [Abstract]: The ongoing COVID-19 pandemic has devastated many countries with ripple effects felt in various sectors of the global economy. In November 2019, the Global Health Security (GHS) Index was released as the first detailed assessment and benchmarking of 195 countries to prevent, detect, and respond to infectious disease threats. This paper presents the first comparison of Organization for Economic Cooperation and Development OECD countries' performance during the pandemic, with the pre-COVID-19 pandemic preparedness as determined by the GHS Index. Using a rank-based analysis, four indices were compared between select countries, including total cases, total deaths, recovery rate, and total tests performed, all standardized for comparison. Our findings suggest a discrepancy between the GHS index rating and the actual performance of countries during this pandemic, with an overestimation of the preparedness of some countries scoring highly on the GHS index and underestimation of the preparedness of other countries with relatively lower scores on the GHS index. [Keywords]:

Virusdisease

Statistical analysis and visualization of the potential cases of pandemic coronavirus.

A local outbreak of initially unknown cause pneumonia was detected in Wuhan (Hubei, China) in December 2019 and a novel coronavirus, the severe acute respiratory syndrome coronavirus 2, was quickly found to be causing it. Since then, the epidemic has spread to all of China's mainland provinces as well as 58 other countries and territories, with more than 87,137 confirmed cases around the globe, including 79,968 from China, 7169 from other countries as of 1 March 2020, as stated by the World Health Organization in the COVID-19 situation report-41. In response to this current public health emergency, this study done a statistical analysis and visualized reported cases of coronavirus disease 2019 (COVID-19) based on the open data collection provided by Johns Hopkins University. Where the location and number of confirmed infected cases have been shown, there have also been deaths, recovered cases and comparisons of the growth rates between the Globe countries. This was intended to provide researchers, public health officials and the general public with exposure to the epidemic.

covid-19;coronavirus;statistical analysis;visual data analysis

Journal Article

Muthusami, R;Saritha, K

10.1007/s13337-020-00610-1

[Title]: Statistical analysis and visualization of the potential cases of pandemic coronavirus. [Abstract]: A local outbreak of initially unknown cause pneumonia was detected in Wuhan (Hubei, China) in December 2019 and a novel coronavirus, the severe acute respiratory syndrome coronavirus 2, was quickly found to be causing it. Since then, the epidemic has spread to all of China's mainland provinces as well as 58 other countries and territories, with more than 87,137 confirmed cases around the globe, including 79,968 from China, 7169 from other countries as of 1 March 2020, as stated by the World Health Organization in the COVID-19 situation report-41. In response to this current public health emergency, this study done a statistical analysis and visualized reported cases of coronavirus disease 2019 (COVID-19) based on the open data collection provided by Johns Hopkins University. Where the location and number of confirmed infected cases have been shown, there have also been deaths, recovered cases and comparisons of the growth rates between the Globe countries. This was intended to provide researchers, public health officials and the general public with exposure to the epidemic. [Keywords]: covid-19;coronavirus;statistical analysis;visual data analysis

Eur Heart J

COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.

AIMS: An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve. METHODS AND RESULTS: We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (rho 0.87, P < 0.001) and for each province separately (Lodi: rho 0.98, P < 0.001; Cremona: rho 0.98, P < 0.001; Pavia: rho 0.87, P < 0.001; Mantova: rho 0.81, P < 0.001). CONCLUSION: The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks.

covid-19;italy;out-of-hospital cardiac arrest;sars-cov-2

Journal Article;Multicenter Study;Research Support, Non-U.S. Gov't

Baldi, Enrico;Sechi, Giuseppe Maria;Mare, Claudio;Canevari, Fabrizio;Brancaglione, Antonella;Primi, Roberto;Klersy, Catherine;Palo, Alessandra;Contri, Enrico;Ronchi, Vincenza;Beretta, Giorgio;Reali, Francesca;Parogni, Pierpaolo;Facchin, Fabio;Rizzi, Ugo;Bussi, Daniele;Ruggeri, Simone;Oltrona Visconti, Luigi;Savastano, Simone

10.1093/eurheartj/ehaa508

[Title]: COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. [Abstract]: AIMS: An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve. METHODS AND RESULTS: We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (rho 0.87, P < 0.001) and for each province separately (Lodi: rho 0.98, P < 0.001; Cremona: rho 0.98, P < 0.001; Pavia: rho 0.87, P < 0.001; Mantova: rho 0.81, P < 0.001). CONCLUSION: The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks. [Keywords]: covid-19;italy;out-of-hospital cardiac arrest;sars-cov-2

Arch Med Res

S1 Subunit and Host Proteases as Potential Therapeutic Avenues for the Treatment of COVID-19.

The novel corona virus (SARS-CoV-2) that causes severe acute respiratory syndrome, now called COVID-19 initially originated in Wuhan city of China and later spread across borders and infected more than five million people and killed over 3.4 lakh people all over the globe. This disease has been announced as pandemic by WHO. So far, there has been not much progress in terms of drug development for fighting against this deadliest virus, also no existing drugs has been reported completely effective for COVID-19 treatment owing to lack of effective therapeutic targets and a broad understanding of the viral behavior in target cell. Some reports have found and confirmed that SARS-CoV-2 like others SARS-CoVs utilizes angiotensin converting enzyme-2 receptor for making entry into target cell by binding to the receptor with its S1 subunit and employing host cell proteases for cleaving S2 subunit at S2' in order to fuse with cell membrane. Thus, simultaneous blocking of S1 subunit and inactivation of proteases seem to be promising therapeutic targets for the development of effective novel drugs. In current write up we hypothesize that S1 subunit and host proteases as potential therapeutic avenues for the treatment of COVID-19.

covid-19;s1 subunit;sars-cov-2;spike (s) transmembrane glycoprotein

Journal Article;Research Support, Non-U.S. Gov't;Review

Arafah, Azher;Ali, Shafat;Yatoo, Ali Mohd;Ali, Md Niamat;Rehman, Muneeb U

10.1016/j.arcmed.2020.05.013

[Title]: S1 Subunit and Host Proteases as Potential Therapeutic Avenues for the Treatment of COVID-19. [Abstract]: The novel corona virus (SARS-CoV-2) that causes severe acute respiratory syndrome, now called COVID-19 initially originated in Wuhan city of China and later spread across borders and infected more than five million people and killed over 3.4 lakh people all over the globe. This disease has been announced as pandemic by WHO. So far, there has been not much progress in terms of drug development for fighting against this deadliest virus, also no existing drugs has been reported completely effective for COVID-19 treatment owing to lack of effective therapeutic targets and a broad understanding of the viral behavior in target cell. Some reports have found and confirmed that SARS-CoV-2 like others SARS-CoVs utilizes angiotensin converting enzyme-2 receptor for making entry into target cell by binding to the receptor with its S1 subunit and employing host cell proteases for cleaving S2 subunit at S2' in order to fuse with cell membrane. Thus, simultaneous blocking of S1 subunit and inactivation of proteases seem to be promising therapeutic targets for the development of effective novel drugs. In current write up we hypothesize that S1 subunit and host proteases as potential therapeutic avenues for the treatment of COVID-19. [Keywords]: covid-19;s1 subunit;sars-cov-2;spike (s) transmembrane glycoprotein

Life Sci

The interaction of RAAS inhibitors with COVID-19: Current progress, perspective and future.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently defined as the worst pandemic disease. SARS-CoV-2 infects human cells via the binding of its S protein to the receptor angiotensin-converting enzyme (ACE2). The use of ACEIs/ARBs (RAAS inhibitors) regulates the renin-angiotensin-aldosterone system (RAAS) and may increase ACE2 expression. Considering the large use of ACEIs/ARBs in hypertensive patients, some professional groups are concerned about whether the use of RAAS inhibitors affects the risk of SARS-CoV-2 infection or the risk of severe illness and mortality in COVID-19 patients. In this review, we summarize preclinical and clinical studies to investigate whether the use of ACEIs/ARBs increases ACE2 expression in animals or patients. We also analyzed whether the use of these drugs affects the risk of SARS-CoV-2 infection, severe illness or mortality based on recent studies. Finally, the review suggests that current evidence does not support the concerns.

ace2;covid-19;raas inhibitor;sars-cov-2

Journal Article;Review

Zhang, Jishou;Wang, Menglong;Ding, Wen;Wan, Jun

10.1016/j.lfs.2020.118142

[Title]: The interaction of RAAS inhibitors with COVID-19: Current progress, perspective and future. [Abstract]: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently defined as the worst pandemic disease. SARS-CoV-2 infects human cells via the binding of its S protein to the receptor angiotensin-converting enzyme (ACE2). The use of ACEIs/ARBs (RAAS inhibitors) regulates the renin-angiotensin-aldosterone system (RAAS) and may increase ACE2 expression. Considering the large use of ACEIs/ARBs in hypertensive patients, some professional groups are concerned about whether the use of RAAS inhibitors affects the risk of SARS-CoV-2 infection or the risk of severe illness and mortality in COVID-19 patients. In this review, we summarize preclinical and clinical studies to investigate whether the use of ACEIs/ARBs increases ACE2 expression in animals or patients. We also analyzed whether the use of these drugs affects the risk of SARS-CoV-2 infection, severe illness or mortality based on recent studies. Finally, the review suggests that current evidence does not support the concerns. [Keywords]: ace2;covid-19;raas inhibitor;sars-cov-2

Viruses

Of Mice and Men: The Coronavirus MHV and Mouse Models as a Translational Approach to Understand SARS-CoV-2.

The fatal acute respiratory coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since COVID-19 was declared a pandemic by the World Health Organization in March 2020, infection and mortality rates have been rising steadily worldwide. The lack of a vaccine, as well as preventive and therapeutic strategies, emphasize the need to develop new strategies to mitigate SARS-CoV-2 transmission and pathogenesis. Since mouse hepatitis virus (MHV), severe acute respiratory syndrome coronavirus (SARS-CoV), and SARS-CoV-2 share a common genus, lessons learnt from MHV and SARS-CoV could offer mechanistic insights into SARS-CoV-2. This review provides a comprehensive review of MHV in mice and SARS-CoV-2 in humans, thereby highlighting further translational avenues in the development of innovative strategies in controlling the detrimental course of SARS-CoV-2. Specifically, we have focused on various aspects, including host species, organotropism, transmission, clinical disease, pathogenesis, control and therapy, MHV as a model for SARS-CoV and SARS-CoV-2 as well as mouse models for infection with SARS-CoV and SARS-CoV-2. While MHV in mice and SARS-CoV-2 in humans share various similarities, there are also differences that need to be addressed when studying murine models. Translational approaches, such as humanized mouse models are pivotal in studying the clinical course and pathology observed in COVID-19 patients. Lessons from prior murine studies on coronavirus, coupled with novel murine models could offer new promising avenues for treatment of COVID-19.

covid-19;sars-cov-2;mouse hepatitis virus (mhv);viral infection

Journal Article;Review

Korner, Robert W;Majjouti, Mohamed;Alcazar, Miguel A Alejandre;Mahabir, Esther

10.3390/v12080880

[Title]: Of Mice and Men: The Coronavirus MHV and Mouse Models as a Translational Approach to Understand SARS-CoV-2. [Abstract]: The fatal acute respiratory coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since COVID-19 was declared a pandemic by the World Health Organization in March 2020, infection and mortality rates have been rising steadily worldwide. The lack of a vaccine, as well as preventive and therapeutic strategies, emphasize the need to develop new strategies to mitigate SARS-CoV-2 transmission and pathogenesis. Since mouse hepatitis virus (MHV), severe acute respiratory syndrome coronavirus (SARS-CoV), and SARS-CoV-2 share a common genus, lessons learnt from MHV and SARS-CoV could offer mechanistic insights into SARS-CoV-2. This review provides a comprehensive review of MHV in mice and SARS-CoV-2 in humans, thereby highlighting further translational avenues in the development of innovative strategies in controlling the detrimental course of SARS-CoV-2. Specifically, we have focused on various aspects, including host species, organotropism, transmission, clinical disease, pathogenesis, control and therapy, MHV as a model for SARS-CoV and SARS-CoV-2 as well as mouse models for infection with SARS-CoV and SARS-CoV-2. While MHV in mice and SARS-CoV-2 in humans share various similarities, there are also differences that need to be addressed when studying murine models. Translational approaches, such as humanized mouse models are pivotal in studying the clinical course and pathology observed in COVID-19 patients. Lessons from prior murine studies on coronavirus, coupled with novel murine models could offer new promising avenues for treatment of COVID-19. [Keywords]: covid-19;sars-cov-2;mouse hepatitis virus (mhv);viral infection

Int J Environ Res Public Health

Encouraging and Enabling Lifestyles and Behaviours to Simultaneously Promote Environmental Sustainability, Health and Equity: Key Policy Messages from INHERIT.

Human consumption and activity are damaging the global ecosystem and the resources on which we rely for health, well-being and survival. The COVID-19 crisis is yet another manifestation of the urgent need to transition to more sustainable societies, further exposing the weaknesses in health systems and the injustice in our societies. It also underlines that many of the factors leading to environmental degradation, ill health and social and health inequities are interlinked. The current situation provides an unprecedented opportunity to invest in initiatives that address these common factors and encourage people to live more healthily and sustainably. Such initiatives can generate the positive feedback loops needed to change the systems and structures that shape our lives. INHERIT (January 2016-December 2019), an ambitious, multisectoral and transnational research project that involved 18 organisations across Europe, funded by the European Commission, explored such solutions. It identified, defined and analysed promising inter-sectoral policies, practices and approaches to simultaneously promote environmental sustainability, protect and promote health and contribute to health equity (the INHERIT "triple-win") and that can encourage and enable people to live, move and consume more healthfully and sustainably. It also explored the facilitators and barriers to working across sectors and in public private cooperation. The insights were brought together in guidelines setting out how policy makers can help instigate and support local "triple-win" initiatives that influence behaviours as an approach to contributing to the change that is so urgently needed to stem environmental degradation and the interlinked threats to health and wellbeing. This article sets out this guidance, providing timely insights on how to "build back better" in the post pandemic era.

behaviour change;environment;equity;health;health equity;intersectoral cooperation;policy;sustainable development;systemic change

Journal Article;Research Support, Non-U.S. Gov't;Review

Stegeman, Ingrid;Godfrey, Alba;Romeo-Velilla, Maria;Bell, Ruth;Staatsen, Brigit;van der Vliet, Nina;Kruize, Hanneke;Morris, George;Taylor, Timothy;Strube, Rosa;Anthun, Kirsti;Lillefjell, Monica;Zverinova, Iva;Scasny, Milan;Maca, Vojtech;Costongs, Caroline

10.3390/ijerph17197166

[Title]: Encouraging and Enabling Lifestyles and Behaviours to Simultaneously Promote Environmental Sustainability, Health and Equity: Key Policy Messages from INHERIT. [Abstract]: Human consumption and activity are damaging the global ecosystem and the resources on which we rely for health, well-being and survival. The COVID-19 crisis is yet another manifestation of the urgent need to transition to more sustainable societies, further exposing the weaknesses in health systems and the injustice in our societies. It also underlines that many of the factors leading to environmental degradation, ill health and social and health inequities are interlinked. The current situation provides an unprecedented opportunity to invest in initiatives that address these common factors and encourage people to live more healthily and sustainably. Such initiatives can generate the positive feedback loops needed to change the systems and structures that shape our lives. INHERIT (January 2016-December 2019), an ambitious, multisectoral and transnational research project that involved 18 organisations across Europe, funded by the European Commission, explored such solutions. It identified, defined and analysed promising inter-sectoral policies, practices and approaches to simultaneously promote environmental sustainability, protect and promote health and contribute to health equity (the INHERIT "triple-win") and that can encourage and enable people to live, move and consume more healthfully and sustainably. It also explored the facilitators and barriers to working across sectors and in public private cooperation. The insights were brought together in guidelines setting out how policy makers can help instigate and support local "triple-win" initiatives that influence behaviours as an approach to contributing to the change that is so urgently needed to stem environmental degradation and the interlinked threats to health and wellbeing. This article sets out this guidance, providing timely insights on how to "build back better" in the post pandemic era. [Keywords]: behaviour change;environment;equity;health;health equity;intersectoral cooperation;policy;sustainable development;systemic change

Proc Natl Acad Sci U S A

Universal vote-by-mail has no impact on partisan turnout or vote share.

In response to coronavirus disease 2019 (COVID-19), many scholars and policy makers are urging the United States to expand voting-by-mail programs to safeguard the electoral process. What are the effects of vote-by-mail? In this paper, we provide a comprehensive design-based analysis of the effect of universal vote-by-mail-a policy under which every voter is mailed a ballot in advance of the election-on electoral outcomes. We collect data from 1996 to 2018 on all three US states that implemented universal vote-by-mail in a staggered fashion across counties, allowing us to use a difference-in-differences design at the county level to estimate causal effects. We find that 1) universal vote-by-mail does not appear to affect either party's share of turnout, 2) universal vote-by-mail does not appear to increase either party's vote share, and 3) universal vote-by-mail modestly increases overall average turnout rates, in line with previous estimates. All three conclusions support the conventional wisdom of election administration experts and contradict many popular claims in the media.

covid-19;elections;partisanship;vote-by-mail

Journal Article

Thompson, Daniel M;Wu, Jennifer A;Yoder, Jesse;Hall, Andrew B

10.1073/pnas.2007249117

[Title]: Universal vote-by-mail has no impact on partisan turnout or vote share. [Abstract]: In response to coronavirus disease 2019 (COVID-19), many scholars and policy makers are urging the United States to expand voting-by-mail programs to safeguard the electoral process. What are the effects of vote-by-mail? In this paper, we provide a comprehensive design-based analysis of the effect of universal vote-by-mail-a policy under which every voter is mailed a ballot in advance of the election-on electoral outcomes. We collect data from 1996 to 2018 on all three US states that implemented universal vote-by-mail in a staggered fashion across counties, allowing us to use a difference-in-differences design at the county level to estimate causal effects. We find that 1) universal vote-by-mail does not appear to affect either party's share of turnout, 2) universal vote-by-mail does not appear to increase either party's vote share, and 3) universal vote-by-mail modestly increases overall average turnout rates, in line with previous estimates. All three conclusions support the conventional wisdom of election administration experts and contradict many popular claims in the media. [Keywords]: covid-19;elections;partisanship;vote-by-mail

Rev Esp Anestesiol Reanim

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study.

BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12(th) to May 26(th), 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10(-16)), shock (42% vs. 14%; P<10(-13)), and arrhythmias (24% vs. 11%; P<10(-4)). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10(-7)), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10(-4))], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Journal Article;Multicenter Study;Observational Study

Ferrando, C;Mellado-Artigas, R;Gea, A;Arruti, E;Aldecoa, C;Bordell, A;Adalia, R;Zattera, L;Ramasco, F;Monedero, P;Maseda, E;Martinez, A;Tamayo, G;Mercadal, J;Munoz, G;Jacas, A;Angeles, G;Castro, P;Hernandez-Tejero, M;Fernandez, J;Gomez-Rojo, M;Candela, A;Ripolles, J;Nieto, A;Bassas, E;Deiros, C;Margarit, A;Redondo, F J;Martin, A;Garcia, N;Casas, P;Morcillo, C;Hernandez-Sanz, M L

10.1016/j.redar.2020.07.003

[Title]: Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. [Abstract]: BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12(th) to May 26(th), 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10(-16)), shock (42% vs. 14%; P<10(-13)), and arrhythmias (24% vs. 11%; P<10(-4)). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10(-7)), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10(-4))], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%. [Keywords]:

Aging (Albany NY)

Clinical course and characteristics of patients with coronavirus disease 2019 in Wuhan, China: a single-centered, retrospective, observational study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) is the virus responsible for the coronavirus disease 2019(COVID-19) pandemic. Despite the extensive studies aiming to understand the pathology of COVID-19, the clinicopathological characteristics and risk factors associated with COVID-19 remain mostly unclear. In this study, we assessed the clinical course and features of COVID-19 patients. FINDINGS: There were 59 patients (54.1%) that had no fever. One-hundred(91.7%) patients required oxygen therapy, which improved percutaneous oxygen saturation (SpO2). Seventy-two (66.1%) patients aged over 60; these patients were more likely to develop respiratory symptoms. Only 13(11.9%) patients were positive for anti-SARS-CoV-2 antibodies, SARS-CoV-2 nucleic acid, and computed tomography (CT) findings. We found significant differences in age, respiratory symptoms, and heart rates between patients with and without underlying conditions. CONCLUSIONS: Our findings suggest that oxygen plays an important role in the treatment of COVID-19 patients and that age and underlying diseases are significant risk factors for COVID-19. Most COVID-19 patients have no fever, and CT provides higher detection rates than antibody- and nucleic acid-based detection methods. METHODS: We analyzed data from 109 confirmed COVID-19 cases. We compared the clinicopathological characteristic of patients stratified according to age and underlying diseases, as well as assessed the detection rates of different diagnostic methods.

covid-19;sars-cov-2;chronic diseases;infection;risk factors

Journal Article;Observational Study;Research Support, Non-U.S. Gov't

Liu, Yanfang;Liu, Lina;Wang, Ye;Du, Xinyang;Ma, Hong;Yao, Jing

10.18632/aging.103745

[Title]: Clinical course and characteristics of patients with coronavirus disease 2019 in Wuhan, China: a single-centered, retrospective, observational study. [Abstract]: BACKGROUND: Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) is the virus responsible for the coronavirus disease 2019(COVID-19) pandemic. Despite the extensive studies aiming to understand the pathology of COVID-19, the clinicopathological characteristics and risk factors associated with COVID-19 remain mostly unclear. In this study, we assessed the clinical course and features of COVID-19 patients. FINDINGS: There were 59 patients (54.1%) that had no fever. One-hundred(91.7%) patients required oxygen therapy, which improved percutaneous oxygen saturation (SpO2). Seventy-two (66.1%) patients aged over 60; these patients were more likely to develop respiratory symptoms. Only 13(11.9%) patients were positive for anti-SARS-CoV-2 antibodies, SARS-CoV-2 nucleic acid, and computed tomography (CT) findings. We found significant differences in age, respiratory symptoms, and heart rates between patients with and without underlying conditions. CONCLUSIONS: Our findings suggest that oxygen plays an important role in the treatment of COVID-19 patients and that age and underlying diseases are significant risk factors for COVID-19. Most COVID-19 patients have no fever, and CT provides higher detection rates than antibody- and nucleic acid-based detection methods. METHODS: We analyzed data from 109 confirmed COVID-19 cases. We compared the clinicopathological characteristic of patients stratified according to age and underlying diseases, as well as assessed the detection rates of different diagnostic methods. [Keywords]: covid-19;sars-cov-2;chronic diseases;infection;risk factors

Vaccine

Planning for COVID-19 vaccines safety surveillance.

COVID-19 vaccines are the most important tool to stem the pandemic. They are being developed with unprecedented global collaboration and accelerated timelines to achieve WHO Emergency Use Listing, while using regulatory pathways through national regulatory authorities. Alongside preparations to ensure equitable access to the vaccines among people globally, preparations must be made within countries for COVID-19 vaccines safety surveillance on an urgent basis. Safety surveillance must be capable of investigating adverse events of special interest (AESI) and adverse events following immunization to determine a change in the benefit-risk profile of the vaccine, and to be able to anticipate coincidental events that might be attributed to the vaccine. Active surveillance systems should calculate the incidence of background rates of AESI prior to vaccine roll out. These background rates vary tremendously across regions, populations and case ascertainment methods. Active surveillance systems must be established or strengthened now, (including in LMIC), to calculate the background rates. Utilizing standardized case definitions and global standards for AESI will help in harmonization. Vaccine safety communication plans should be developed. Expanding the global vaccine safety system to meet the needs of COVID-19 and other emergency and routine use vaccines is a priority currently.

adverse event following immunization (aefi);adverse event of special interest (aesi);cepi;covid-19;clinical research;coronavirus;epidemic;global vaccine safety blueprint;outbreak;pandemic;sars-cov-2;safety;severe acute respiratory syndrome coronavirus 2;surveillance;vaccines;who

Journal Article;Research Support, Non-U.S. Gov't

Kochhar, Sonali;Salmon, Daniel A

10.1016/j.vaccine.2020.07.013

[Title]: Planning for COVID-19 vaccines safety surveillance. [Abstract]: COVID-19 vaccines are the most important tool to stem the pandemic. They are being developed with unprecedented global collaboration and accelerated timelines to achieve WHO Emergency Use Listing, while using regulatory pathways through national regulatory authorities. Alongside preparations to ensure equitable access to the vaccines among people globally, preparations must be made within countries for COVID-19 vaccines safety surveillance on an urgent basis. Safety surveillance must be capable of investigating adverse events of special interest (AESI) and adverse events following immunization to determine a change in the benefit-risk profile of the vaccine, and to be able to anticipate coincidental events that might be attributed to the vaccine. Active surveillance systems should calculate the incidence of background rates of AESI prior to vaccine roll out. These background rates vary tremendously across regions, populations and case ascertainment methods. Active surveillance systems must be established or strengthened now, (including in LMIC), to calculate the background rates. Utilizing standardized case definitions and global standards for AESI will help in harmonization. Vaccine safety communication plans should be developed. Expanding the global vaccine safety system to meet the needs of COVID-19 and other emergency and routine use vaccines is a priority currently. [Keywords]: adverse event following immunization (aefi);adverse event of special interest (aesi);cepi;covid-19;clinical research;coronavirus;epidemic;global vaccine safety blueprint;outbreak;pandemic;sars-cov-2;safety;severe acute respiratory syndrome coronavirus 2;surveillance;vaccines;who

Indian J Med Res

National sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in India: Protocol for community-based surveillance.

Conducting population-based serosurveillance for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) will estimate and monitor the trend of infection in the adult general population, determine the socio-demographic risk factors and delineate the geographical spread of the infection. For this purpose, a serial cross-sectional survey would be conducted with a sample size of 24,000 distributed equally across four strata of districts categorized on the basis of the incidence of reported cases of COVID-19. Sixty districts will be included in the survey. Simultaneously, the survey will be done in 10 high-burden hotspot cities. ELISA-based antibody tests would be used. Data collection will be done using a mobile-based application. Prevalence from the group of districts in each of the four strata will be pooled to estimate the population prevalence of COVID-19 infection, and similarly for the hotspot cities, after adjusting for demographic characteristics and antibody test performance. The total number of reported cases in the districts and hotspot cities will be adjusted using this seroprevalence to estimate the expected number of infected individuals in the area. Such serosurveys repeated at regular intervals can also guide containment measures in respective areas. State-specific context of disease burden, priorities and resources should guide the use of multifarious surveillance options for the current COVID-19 epidemic.

antibody - covid-19 - hotspot - sars-cov-2 - serial cross-sectional - seroprevalence - surveillance - trend

Journal Article

Kumar, Muthusamy Santhosh;Bhatnagar, Tarun;Manickam, Ponnaiah;Kumar, V Saravana;Rade, Kiran;Shah, Naman;Kant, Shashi;Babu, Giridhara R;Zodpey, Sanjay;Girish Kumar, C P;Vivian Thangaraj, Jeromie Wesley;Chatterjee, Pranab;Kanungo, Suman;Pandey, Ravindra Mohan;Murhekar, Manoj;Singh, Sujeet K;Sarkar, Swarup;Muliyi, J P;Gangakhedkar, Raman R;Reddy, D C S

10.4103/ijmr.IJMR_1818_20

[Title]: National sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in India: Protocol for community-based surveillance. [Abstract]: Conducting population-based serosurveillance for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) will estimate and monitor the trend of infection in the adult general population, determine the socio-demographic risk factors and delineate the geographical spread of the infection. For this purpose, a serial cross-sectional survey would be conducted with a sample size of 24,000 distributed equally across four strata of districts categorized on the basis of the incidence of reported cases of COVID-19. Sixty districts will be included in the survey. Simultaneously, the survey will be done in 10 high-burden hotspot cities. ELISA-based antibody tests would be used. Data collection will be done using a mobile-based application. Prevalence from the group of districts in each of the four strata will be pooled to estimate the population prevalence of COVID-19 infection, and similarly for the hotspot cities, after adjusting for demographic characteristics and antibody test performance. The total number of reported cases in the districts and hotspot cities will be adjusted using this seroprevalence to estimate the expected number of infected individuals in the area. Such serosurveys repeated at regular intervals can also guide containment measures in respective areas. State-specific context of disease burden, priorities and resources should guide the use of multifarious surveillance options for the current COVID-19 epidemic. [Keywords]: antibody - covid-19 - hotspot - sars-cov-2 - serial cross-sectional - seroprevalence - surveillance - trend

SN Compr Clin Med

Polymorphic Ventricular Tachycardia with a Normal QTc Interval in a Patient with COVID-19 and Fever: Case Report.

Arrhythmias or conduction system disease are not the most common manifestation of COVID-19 infection in patients requiring hospital admission. Torsade de pointes typically occurs in bursts of self-limiting episodes with symptoms of dizziness and syncope. However, it may occasionally progress to ventricular fibrillation and sudden death. In this article, we report a case of COVID-19 patient who developed polymorphic ventricular tachycardia with torsade de pointes morphology with normal QTc interval in the setting of fever. An 81-year-old woman was admitted with symptoms of COVID-19. She was treated with hydroxychloroquine, azithromycin, and doxycycline at an outside facility and finished the treatment 5 days prior to admission to our facility. Her course was complicated by atrial fibrillation with rapid ventricular response requiring cardioversion. Later, she developed two episodes of polymorphic ventricular tachycardia with TdP morphology with normal QTc. There was a correlation with fever triggering the ventricular tachycardia. We advocated aggressive fever control given the QTc was normal and stable. Following fever control, the patient remained stable and had no abnormal rhythm. COVID-19 patients are prone to different arrhythmias including life-threatening ventricular arrhythmias with normal left ventricular systolic function and normal QTc, and they should be monitored for fever and electrolyte abnormality during their hospital stay.

arrhythmias;covid-19;polymorphic ventricular tachycardia;severe acute respiratory syndrome coronavirus-2;torsade de pointes

Journal Article

Babapoor-Farrokhran, Savalan;Port, Zachary;Wiener, Philip C;Amanullah, Aman;Mainigi, Sumeet K

10.1007/s42399-020-00531-6

[Title]: Polymorphic Ventricular Tachycardia with a Normal QTc Interval in a Patient with COVID-19 and Fever: Case Report. [Abstract]: Arrhythmias or conduction system disease are not the most common manifestation of COVID-19 infection in patients requiring hospital admission. Torsade de pointes typically occurs in bursts of self-limiting episodes with symptoms of dizziness and syncope. However, it may occasionally progress to ventricular fibrillation and sudden death. In this article, we report a case of COVID-19 patient who developed polymorphic ventricular tachycardia with torsade de pointes morphology with normal QTc interval in the setting of fever. An 81-year-old woman was admitted with symptoms of COVID-19. She was treated with hydroxychloroquine, azithromycin, and doxycycline at an outside facility and finished the treatment 5 days prior to admission to our facility. Her course was complicated by atrial fibrillation with rapid ventricular response requiring cardioversion. Later, she developed two episodes of polymorphic ventricular tachycardia with TdP morphology with normal QTc. There was a correlation with fever triggering the ventricular tachycardia. We advocated aggressive fever control given the QTc was normal and stable. Following fever control, the patient remained stable and had no abnormal rhythm. COVID-19 patients are prone to different arrhythmias including life-threatening ventricular arrhythmias with normal left ventricular systolic function and normal QTc, and they should be monitored for fever and electrolyte abnormality during their hospital stay. [Keywords]: arrhythmias;covid-19;polymorphic ventricular tachycardia;severe acute respiratory syndrome coronavirus-2;torsade de pointes

J Clin Microbiol

Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans.

Discovery of bats with severe acute respiratory syndrome (SARS)-related coronaviruses (CoVs) raised the specter of potential future outbreaks of zoonotic SARS-CoV-like disease in humans, which largely went unheeded. Nevertheless, the novel SARS-CoV-2 of bat ancestral origin emerged to infect humans in Wuhan, China, in late 2019 and then became a global pandemic. Less than 5 months after its emergence, millions of people worldwide have been infected asymptomatically or symptomatically and at least 360,000 have died. Coronavirus disease 2019 (COVID-19) in severely affected patients includes atypical pneumonia characterized by a dry cough, persistent fever, and progressive dyspnea and hypoxia, sometimes accompanied by diarrhea and often followed by multiple organ failure, especially of the respiratory and cardiovascular systems. In this minireview, we focus on two endemic respiratory CoV infections of livestock: bovine coronavirus (BCoV) and porcine respiratory coronavirus (PRCV). Both animal respiratory CoVs share some common features with SARS-CoV and SARS-CoV-2. BCoV has a broad host range including wild ruminants and a zoonotic potential. BCoV also has a dual tropism for the respiratory and gastrointestinal tracts. These aspects, their interspecies transmission, and certain factors that impact disease severity in cattle parallel related facets of SARS-CoV or SARS-CoV-2 in humans. PRCV has a tissue tropism for the upper and lower respiratory tracts and a cellular tropism for type 1 and 2 pneumocytes in lung but is generally a mild infection unless complicated by other exacerbating factors, such as bacterial or viral coinfections and immunosuppression (corticosteroids).

covid-19;sars;sars-cov-2;animal coronaviruses;bovine respiratory coronavirus;pathogenesis;porcine respiratory coronavirus

Comparative Study;Journal Article;Review

Saif, Linda J;Jung, Kwonil

10.1128/JCM.01355-20

[Title]: Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans. [Abstract]: Discovery of bats with severe acute respiratory syndrome (SARS)-related coronaviruses (CoVs) raised the specter of potential future outbreaks of zoonotic SARS-CoV-like disease in humans, which largely went unheeded. Nevertheless, the novel SARS-CoV-2 of bat ancestral origin emerged to infect humans in Wuhan, China, in late 2019 and then became a global pandemic. Less than 5 months after its emergence, millions of people worldwide have been infected asymptomatically or symptomatically and at least 360,000 have died. Coronavirus disease 2019 (COVID-19) in severely affected patients includes atypical pneumonia characterized by a dry cough, persistent fever, and progressive dyspnea and hypoxia, sometimes accompanied by diarrhea and often followed by multiple organ failure, especially of the respiratory and cardiovascular systems. In this minireview, we focus on two endemic respiratory CoV infections of livestock: bovine coronavirus (BCoV) and porcine respiratory coronavirus (PRCV). Both animal respiratory CoVs share some common features with SARS-CoV and SARS-CoV-2. BCoV has a broad host range including wild ruminants and a zoonotic potential. BCoV also has a dual tropism for the respiratory and gastrointestinal tracts. These aspects, their interspecies transmission, and certain factors that impact disease severity in cattle parallel related facets of SARS-CoV or SARS-CoV-2 in humans. PRCV has a tissue tropism for the upper and lower respiratory tracts and a cellular tropism for type 1 and 2 pneumocytes in lung but is generally a mild infection unless complicated by other exacerbating factors, such as bacterial or viral coinfections and immunosuppression (corticosteroids). [Keywords]: covid-19;sars;sars-cov-2;animal coronaviruses;bovine respiratory coronavirus;pathogenesis;porcine respiratory coronavirus

Int J Infect Dis

Management of a COVID-19 outbreak in a hotel in Tenerife, Spain.

Since the first accounts of SARS-CoV-2, authorities have encountered numerous unprecedented situations threatening public health. This rapid communication addresses events that led to the quarantining of a hotel in Tenerife, Spain and the effectiveness of the rapidly implemented control measures. In total, eight cases have been associated with the hotel. Due to the international nature of the guests, had these timely precautions not been in place, a multinational cluster might have formed.

covid-19;hotel;outbreak;outbreak control;quarantine;rapid response

Case Reports

Hoefer, Andreas;Pampaka, Despina;Rivas Wagner, Eva;Aleman Herrera, Araceli;Garcia-Ramos Alonso, Eduardo;Lopez-Perea, Noemi;Cano Portero, Rosa;Herrera-Leon, Laura;Herrera-Leon, Silvia;Nunez Gallo, Domingo

10.1016/j.ijid.2020.05.047

[Title]: Management of a COVID-19 outbreak in a hotel in Tenerife, Spain. [Abstract]: Since the first accounts of SARS-CoV-2, authorities have encountered numerous unprecedented situations threatening public health. This rapid communication addresses events that led to the quarantining of a hotel in Tenerife, Spain and the effectiveness of the rapidly implemented control measures. In total, eight cases have been associated with the hotel. Due to the international nature of the guests, had these timely precautions not been in place, a multinational cluster might have formed. [Keywords]: covid-19;hotel;outbreak;outbreak control;quarantine;rapid response

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue

[Effect of Xuebijing injection on inflammatory markers and disease outcome of coronavirus disease 2019].

OBJECTIVE: To observe the influence of Xuebijing injection on the inflammatory markers and prognosis of coronavirus disease 2019 (COVID-19) patients. METHODS: Sixty severe COVID-19 patients admitted to Changsha Public Health Treatment Center (North Hospital of the First Hospital of Changsha City) from January to March in 2020 were randomly divided into routine treatment group, Xuebijing 50 mL group and Xuebijing 100 mL group, with 20 cases in each group. The routine treatment group was treated according to the National Health Commission's guide for COVID-19. On the basis of conventional treatment, Xuebijing injection was injected by 50 mL twice a day for 7 days in Xuebijing 50 mL group, while by 100 mL twice a day for 7 days in Xuebijing 100 mL group. The blood routine test, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acute physiology and chronic health evaluation II (APACHE II) score, 2019 novel coronavirus (2019-nCoV) nucleic acid test and disease classification of three groups before and 8 days after treatment were observed. RESULTS: (1) After treatment, the white blood cell count (WBC) and lymphocyte count (LYM) of three groups increased, meanwhile CRP and ESR decreased. Compared with routine treatment group, the WBC count of Xuebijing 100 mL group after treatment significantly increased (x10(9)/L: 7.12+/-0.55 vs. 5.67+/-0.51, P < 0.05), and the levels of CRP and ESR in Xuebijing 50 mL and 100 mL groups significantly decreased [CRP (mg/L): 32.3+/-4.6, 28.0+/-6.2 vs. 37.3+/-5.9; ESR (mm/1 h): 45.9+/-5.7, 40.5+/-7.4 vs. 55.3+/-6.6, all P < 0.05]. Compared with Xuebijing 50 mL group, the increase of WBC, and the decrease of CRP and ESR were more significant in Xuebijing 100 mL group [WBC (x10(9)/L): 7.12+/-0.55 vs. 5.82+/-0.49, CRP (mg/L): 28.0+/-6.2 vs. 32.3+/-4.6, ESR (mm/1 h): 40.5+/-7.4 vs. 45.9+/-5.7, all P < 0.05]. (2) After treatment, the APACHE II score of three groups decreased. In Xuebijing 100 mL group, the APACHE II score after treatment was significantly lower than those in routine treatment and Xuebijing 50 mL groups (12.3+/-1.5 vs. 16.5+/-1.6, 15.9+/-1.4, both P < 0.05). After treatment, the 2019-nCoV nucleic acid test in three groups partly turned negative, with 9 cases in routine treatment group, 8 cases in Xuebijing 50 mL group and 9 cases in Xuebijing 100 mL group, without significant difference (P > 0.05). The conditions of patients in the three groups were improved after treatment, among them, 8 cases in the routine treatment group were transformed into common type, 1 case into critical type; 9 cases and 12 cases of Xuebijing 50 mL group and 100 mL group were transformed into common type respectively. Xuebijing 100 mL group was improved more obviously than Xuebijing 50 mL group and routine treatment group (both P < 0.05). CONCLUSIONS: The Xuebijing injection can effectively improve the inflammatory markers and prognosis of severe COVID-19 patients.

Journal Article;Randomized Controlled Trial

Wen, Long;Zhou, Zhiguo;Jiang, Dixuan;Huang, Kang

10.3760/cma.j.cn121430-20200406-00386

[Title]: [Effect of Xuebijing injection on inflammatory markers and disease outcome of coronavirus disease 2019]. [Abstract]: OBJECTIVE: To observe the influence of Xuebijing injection on the inflammatory markers and prognosis of coronavirus disease 2019 (COVID-19) patients. METHODS: Sixty severe COVID-19 patients admitted to Changsha Public Health Treatment Center (North Hospital of the First Hospital of Changsha City) from January to March in 2020 were randomly divided into routine treatment group, Xuebijing 50 mL group and Xuebijing 100 mL group, with 20 cases in each group. The routine treatment group was treated according to the National Health Commission's guide for COVID-19. On the basis of conventional treatment, Xuebijing injection was injected by 50 mL twice a day for 7 days in Xuebijing 50 mL group, while by 100 mL twice a day for 7 days in Xuebijing 100 mL group. The blood routine test, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acute physiology and chronic health evaluation II (APACHE II) score, 2019 novel coronavirus (2019-nCoV) nucleic acid test and disease classification of three groups before and 8 days after treatment were observed. RESULTS: (1) After treatment, the white blood cell count (WBC) and lymphocyte count (LYM) of three groups increased, meanwhile CRP and ESR decreased. Compared with routine treatment group, the WBC count of Xuebijing 100 mL group after treatment significantly increased (x10(9)/L: 7.12+/-0.55 vs. 5.67+/-0.51, P < 0.05), and the levels of CRP and ESR in Xuebijing 50 mL and 100 mL groups significantly decreased [CRP (mg/L): 32.3+/-4.6, 28.0+/-6.2 vs. 37.3+/-5.9; ESR (mm/1 h): 45.9+/-5.7, 40.5+/-7.4 vs. 55.3+/-6.6, all P < 0.05]. Compared with Xuebijing 50 mL group, the increase of WBC, and the decrease of CRP and ESR were more significant in Xuebijing 100 mL group [WBC (x10(9)/L): 7.12+/-0.55 vs. 5.82+/-0.49, CRP (mg/L): 28.0+/-6.2 vs. 32.3+/-4.6, ESR (mm/1 h): 40.5+/-7.4 vs. 45.9+/-5.7, all P < 0.05]. (2) After treatment, the APACHE II score of three groups decreased. In Xuebijing 100 mL group, the APACHE II score after treatment was significantly lower than those in routine treatment and Xuebijing 50 mL groups (12.3+/-1.5 vs. 16.5+/-1.6, 15.9+/-1.4, both P < 0.05). After treatment, the 2019-nCoV nucleic acid test in three groups partly turned negative, with 9 cases in routine treatment group, 8 cases in Xuebijing 50 mL group and 9 cases in Xuebijing 100 mL group, without significant difference (P > 0.05). The conditions of patients in the three groups were improved after treatment, among them, 8 cases in the routine treatment group were transformed into common type, 1 case into critical type; 9 cases and 12 cases of Xuebijing 50 mL group and 100 mL group were transformed into common type respectively. Xuebijing 100 mL group was improved more obviously than Xuebijing 50 mL group and routine treatment group (both P < 0.05). CONCLUSIONS: The Xuebijing injection can effectively improve the inflammatory markers and prognosis of severe COVID-19 patients. [Keywords]:

Radiography (Lond)

COVID-19 in the radiology department: What radiographers need to know.

OBJECTIVES: The aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases. KEY FINDINGS: Medical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive. CONCLUSION: As radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan. IMPLICATIONS FOR PRACTICE: At the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.

covid-19;ct;chest;guidelines;imaging;radiography

Journal Article;Research Support, Non-U.S. Gov't;Review

Stogiannos, N;Fotopoulos, D;Woznitza, N;Malamateniou, C

10.1016/j.radi.2020.05.012

[Title]: COVID-19 in the radiology department: What radiographers need to know. [Abstract]: OBJECTIVES: The aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases. KEY FINDINGS: Medical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive. CONCLUSION: As radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan. IMPLICATIONS FOR PRACTICE: At the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments. [Keywords]: covid-19;ct;chest;guidelines;imaging;radiography

Braz Oral Res

Knowledge about Coronavirus disease 19 (COVID-19) and its professional repercussions among Brazilian endodontists.

The aim of this study was to assess Brazilian endodontists' level of knowledge about the coronavirus disease (COVID-19) and examine its professional repercussions. The link to the online survey that was created for this study was shared with Brazilian endodontists through social networking applications. The questionnaire contained questions that pertained to COVID-19 and its impact on dental practice. The collected data were analyzed using t-test, chi-square analysis, and analysis of variance, and the level of significance was set at 0.05. A total of 2,135 participants responded to the questionnaire, and all five Brazilian regions were represented in the sample. A total of 98.50% of endodontists reported that dental procedures can transmit COVID-19. Complete social distancing was practiced by 96.68% of the participants, and approximately 25% knew someone who had COVID-19. Moreover, in their daily practice, 72.13% of them implemented biosecurity measures that are ineffective in preventing COVID-19. Furthermore, 91.7% of them reportedly suspended elective dental procedures. Only 55.69% of them reported that they performed only emergency procedures in their workplaces. Those who believed that COVID-19 cannot be transmitted during dental procedures were less knowledgeable about the symptoms of COVID-19 (p = 0.0095). Endodontists who believed that personal protective equipment cannot prevent contamination were more knowledgeable about the symptoms of COVID-19 than their counterparts (p = 0.0003). The participating Brazilian endodontists demonstrated adequate knowledge about the risk of contamination during dental procedures and the main symptoms of COVID-19. Only some professionals reported providing emergency dental care during the pandemic.

Journal Article

Candeiro, George Taccio de Miranda;Gavini, Giulio;Vivan, Rodrigo Ricci;Carvalho, Bruna Marjorie Dias Frota;Duarte, Marco Antonio Hungaro;FeijAo, Camila Pontes;FeijAo, Camila Pontes

10.1590/1807-3107bor-2020.vol34.0117

[Title]: Knowledge about Coronavirus disease 19 (COVID-19) and its professional repercussions among Brazilian endodontists. [Abstract]: The aim of this study was to assess Brazilian endodontists' level of knowledge about the coronavirus disease (COVID-19) and examine its professional repercussions. The link to the online survey that was created for this study was shared with Brazilian endodontists through social networking applications. The questionnaire contained questions that pertained to COVID-19 and its impact on dental practice. The collected data were analyzed using t-test, chi-square analysis, and analysis of variance, and the level of significance was set at 0.05. A total of 2,135 participants responded to the questionnaire, and all five Brazilian regions were represented in the sample. A total of 98.50% of endodontists reported that dental procedures can transmit COVID-19. Complete social distancing was practiced by 96.68% of the participants, and approximately 25% knew someone who had COVID-19. Moreover, in their daily practice, 72.13% of them implemented biosecurity measures that are ineffective in preventing COVID-19. Furthermore, 91.7% of them reportedly suspended elective dental procedures. Only 55.69% of them reported that they performed only emergency procedures in their workplaces. Those who believed that COVID-19 cannot be transmitted during dental procedures were less knowledgeable about the symptoms of COVID-19 (p = 0.0095). Endodontists who believed that personal protective equipment cannot prevent contamination were more knowledgeable about the symptoms of COVID-19 than their counterparts (p = 0.0003). The participating Brazilian endodontists demonstrated adequate knowledge about the risk of contamination during dental procedures and the main symptoms of COVID-19. Only some professionals reported providing emergency dental care during the pandemic. [Keywords]:

Front Immunol

Overview of Immune Response During SARS-CoV-2 Infection: Lessons From the Past.

After the 1918 flu pandemic, the world is again facing a similar situation. However, the advancement in medical science has made it possible to identify that the novel infectious agent is from the coronavirus family. Rapid genome sequencing by various groups helped in identifying the structure and function of the virus, its immunogenicity in diverse populations, and potential preventive measures. Coronavirus attacks the respiratory system, causing pneumonia and lymphopenia in infected individuals. Viral components like spike and nucleocapsid proteins trigger an immune response in the host to eliminate the virus. These viral antigens can be either recognized by the B cells or presented by MHC complexes to the T cells, resulting in antibody production, increased cytokine secretion, and cytolytic activity in the acute phase of infection. Genetic polymorphism in MHC enables it to present some of the T cell epitopes very well over the other MHC alleles. The association of MHC alleles and its downregulated expression has been correlated with disease severity against influenza and coronaviruses. Studies have reported that infected individuals can, after recovery, induce strong protective responses by generating a memory T-cell pool against SARS-CoV and MERS-CoV. These memory T cells were not persistent in the long term and, upon reactivation, caused local damage due to cross-reactivity. So far, the reports suggest that SARS-CoV-2, which is highly contagious, shows related symptoms in three different stages and develops an exhaustive T-cell pool at higher loads of viral infection. As there are no specific treatments available for this novel coronavirus, numerous small molecular drugs that are being used for the treatment of diseases like SARS, MERS, HIV, ebola, malaria, and tuberculosis are being given to COVID-19 patients, and clinical trials for many such drugs have already begun. A classical immunotherapy of convalescent plasma transfusion from recovered patients has also been initiated for the neutralization of viremia in terminally ill COVID-19 patients. Due to the limitations of plasma transfusion, researchers are now focusing on developing neutralizing antibodies against virus particles along with immuno-modulation of cytokines like IL-6, Type I interferons (IFNs), and TNF-alpha that could help in combating the infection. This review highlights the similarities of the coronaviruses that caused SARS and MERS to the novel SARS-CoV-2 in relation to their pathogenicity and immunogenicity and also focuses on various treatment strategies that could be employed for curing COVID-19.

covid-19;hla;mhc presentation;t cells;coronavirus;immune response;memory t cell

Journal Article;Research Support, Non-U.S. Gov't;Review

Shah, Vibhuti Kumar;Firmal, Priyanka;Alam, Aftab;Ganguly, Dipyaman;Chattopadhyay, Samit

10.3389/fimmu.2020.01949

[Title]: Overview of Immune Response During SARS-CoV-2 Infection: Lessons From the Past. [Abstract]: After the 1918 flu pandemic, the world is again facing a similar situation. However, the advancement in medical science has made it possible to identify that the novel infectious agent is from the coronavirus family. Rapid genome sequencing by various groups helped in identifying the structure and function of the virus, its immunogenicity in diverse populations, and potential preventive measures. Coronavirus attacks the respiratory system, causing pneumonia and lymphopenia in infected individuals. Viral components like spike and nucleocapsid proteins trigger an immune response in the host to eliminate the virus. These viral antigens can be either recognized by the B cells or presented by MHC complexes to the T cells, resulting in antibody production, increased cytokine secretion, and cytolytic activity in the acute phase of infection. Genetic polymorphism in MHC enables it to present some of the T cell epitopes very well over the other MHC alleles. The association of MHC alleles and its downregulated expression has been correlated with disease severity against influenza and coronaviruses. Studies have reported that infected individuals can, after recovery, induce strong protective responses by generating a memory T-cell pool against SARS-CoV and MERS-CoV. These memory T cells were not persistent in the long term and, upon reactivation, caused local damage due to cross-reactivity. So far, the reports suggest that SARS-CoV-2, which is highly contagious, shows related symptoms in three different stages and develops an exhaustive T-cell pool at higher loads of viral infection. As there are no specific treatments available for this novel coronavirus, numerous small molecular drugs that are being used for the treatment of diseases like SARS, MERS, HIV, ebola, malaria, and tuberculosis are being given to COVID-19 patients, and clinical trials for many such drugs have already begun. A classical immunotherapy of convalescent plasma transfusion from recovered patients has also been initiated for the neutralization of viremia in terminally ill COVID-19 patients. Due to the limitations of plasma transfusion, researchers are now focusing on developing neutralizing antibodies against virus particles along with immuno-modulation of cytokines like IL-6, Type I interferons (IFNs), and TNF-alpha that could help in combating the infection. This review highlights the similarities of the coronaviruses that caused SARS and MERS to the novel SARS-CoV-2 in relation to their pathogenicity and immunogenicity and also focuses on various treatment strategies that could be employed for curing COVID-19. [Keywords]: covid-19;hla;mhc presentation;t cells;coronavirus;immune response;memory t cell

Diabetes Metab Syndr Obes

Increased Metabolic Burden Among Blacks: A Putative Mechanism for Disparate COVID-19 Outcomes.

Mounting evidence shows a disproportionate COVID-19 burden among Blacks. Early findings indicate pre-existing metabolic burden (eg, obesity, hypertension and diabetes) as key drivers of COVID-19 severity. Since Blacks exhibit higher prevalence of metabolic burden, we examined the influence of metabolic syndrome on disparate COVID-19 burden. We analyzed data from a NIH-funded study to characterize metabolic burden among Blacks in New York (Metabolic Syndrome Outcome Study). Patients (n=1035) were recruited from outpatient clinics, where clinical and self-report data were obtained. The vast majority of the sample was overweight/obese (90%); diagnosed with hypertension (93%); dyslipidemia (72%); diabetes (61%); and nearly half of them were at risk for sleep apnea (48%). Older Blacks (age>/=65 years) were characterized by higher levels of metabolic burden and co-morbidities (eg, heart disease, cancer). In multivariate-adjusted regression analyses, age was a significant (p</=.001) independent predictor of hypertension (OR=1.06; 95% CI: 1.04-1.09), diabetes (OR=1.03; 95% CI: 1.02-1.04), and dyslipidemia (OR=0.98; 95% CI: 0.97-0.99), but not obesity. Our study demonstrates an overwhelmingly high prevalence of the metabolic risk factors related to COVID-19 among Blacks in New York, highlighting disparate metabolic burden among Blacks as a possible mechanism conferring the greater burden of COVID-19 infection and mortality represented in published data.

covid-19 burden;blacks;disparities;metabolic risk factors;metabolic syndrome

Journal Article;Review

Jean-Louis, Girardin;Turner, Arlener D;Jin, Peng;Liu, Mengling;Boutin-Foster, Carla;McFarlane, Samy I;Seixas, Azizi

10.2147/DMSO.S267952

[Title]: Increased Metabolic Burden Among Blacks: A Putative Mechanism for Disparate COVID-19 Outcomes. [Abstract]: Mounting evidence shows a disproportionate COVID-19 burden among Blacks. Early findings indicate pre-existing metabolic burden (eg, obesity, hypertension and diabetes) as key drivers of COVID-19 severity. Since Blacks exhibit higher prevalence of metabolic burden, we examined the influence of metabolic syndrome on disparate COVID-19 burden. We analyzed data from a NIH-funded study to characterize metabolic burden among Blacks in New York (Metabolic Syndrome Outcome Study). Patients (n=1035) were recruited from outpatient clinics, where clinical and self-report data were obtained. The vast majority of the sample was overweight/obese (90%); diagnosed with hypertension (93%); dyslipidemia (72%); diabetes (61%); and nearly half of them were at risk for sleep apnea (48%). Older Blacks (age>/=65 years) were characterized by higher levels of metabolic burden and co-morbidities (eg, heart disease, cancer). In multivariate-adjusted regression analyses, age was a significant (p</=.001) independent predictor of hypertension (OR=1.06; 95% CI: 1.04-1.09), diabetes (OR=1.03; 95% CI: 1.02-1.04), and dyslipidemia (OR=0.98; 95% CI: 0.97-0.99), but not obesity. Our study demonstrates an overwhelmingly high prevalence of the metabolic risk factors related to COVID-19 among Blacks in New York, highlighting disparate metabolic burden among Blacks as a possible mechanism conferring the greater burden of COVID-19 infection and mortality represented in published data. [Keywords]: covid-19 burden;blacks;disparities;metabolic risk factors;metabolic syndrome

Brain Nerve

[Important and Unresolved Aspects of Neuropathologic Analyses of COVID-19 Individuals].

The pathomechanisms of central nervous system disorders associated with COVID-19 remain unsolved. It is therefore imperative to carry out pathologic, virologic, and molecular analyses of the human brain tissue to understand the neurological manifestations of COVID-19. However, autopsy of COVID-19 poses challenges in terms of infection control. In this short review, the neuropathologic findings of individuals with COVID-19 were summerised and a possible autopsy methodologies to investigate these further were proposed.

Journal Article

Takao, Masaki

10.11477/mf.1416201649

[Title]: [Important and Unresolved Aspects of Neuropathologic Analyses of COVID-19 Individuals]. [Abstract]: The pathomechanisms of central nervous system disorders associated with COVID-19 remain unsolved. It is therefore imperative to carry out pathologic, virologic, and molecular analyses of the human brain tissue to understand the neurological manifestations of COVID-19. However, autopsy of COVID-19 poses challenges in terms of infection control. In this short review, the neuropathologic findings of individuals with COVID-19 were summerised and a possible autopsy methodologies to investigate these further were proposed. [Keywords]:

Int J Infect Dis

Possible intrauterine SARS-CoV-2 infection: Positive nucleic acid testing results and consecutive positive SARS-CoV-2-specific antibody levels within 50 days after birth.

Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the fetus in utero is important to the well-being of the mother and neonate. We report the case of a full-term neonate born to a mother who developed symptoms of coronavirus disease 2019 (COVID-19) at 32 weeks of gestation. The placental pathology showed slight local inflammation. Serial quantitative antibody measurements in the neonate showed elevated levels of IgM on the day of birth and a gradual decline to negative levels within 28 days of life; the levels of IgG declined gradually, but IgG was still positive on day 50 of life. The sequential dynamic changes in antibody levels in the neonate were consistent with those in his mother. One-step reverse transcriptase droplet digital PCR testing for SARS-CoV-2 nucleic acid in throat and anal swabs showed positive results (750 and 892copies/ml) on day 7 of life and negative results on day 14 of life. The neonate had no symptoms of COVID-19. This report enables us to re-evaluate the significance of IgM detection in intrauterine SARS-CoV-2 infection and presents a favorable prognosis for the neonate with long-term exposure to maternal COVID-19, despite a high possibility of intrauterine infection.

antibody;covid-19;intrauterine infection;nucleic acid testing;placental pathology;sars-cov-2

Case Reports;Journal Article

Gao, Jinzhi;Hu, Xiaolin;Sun, Xuan;Luo, Xiaoping;Chen, Ling

10.1016/j.ijid.2020.07.063

[Title]: Possible intrauterine SARS-CoV-2 infection: Positive nucleic acid testing results and consecutive positive SARS-CoV-2-specific antibody levels within 50 days after birth. [Abstract]: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the fetus in utero is important to the well-being of the mother and neonate. We report the case of a full-term neonate born to a mother who developed symptoms of coronavirus disease 2019 (COVID-19) at 32 weeks of gestation. The placental pathology showed slight local inflammation. Serial quantitative antibody measurements in the neonate showed elevated levels of IgM on the day of birth and a gradual decline to negative levels within 28 days of life; the levels of IgG declined gradually, but IgG was still positive on day 50 of life. The sequential dynamic changes in antibody levels in the neonate were consistent with those in his mother. One-step reverse transcriptase droplet digital PCR testing for SARS-CoV-2 nucleic acid in throat and anal swabs showed positive results (750 and 892copies/ml) on day 7 of life and negative results on day 14 of life. The neonate had no symptoms of COVID-19. This report enables us to re-evaluate the significance of IgM detection in intrauterine SARS-CoV-2 infection and presents a favorable prognosis for the neonate with long-term exposure to maternal COVID-19, despite a high possibility of intrauterine infection. [Keywords]: antibody;covid-19;intrauterine infection;nucleic acid testing;placental pathology;sars-cov-2

J Med Internet Res

The Art of Surgery: Balancing Compassionate With Virtual Care.

The recent drive to include virtual care in surgical practice has been accelerated due to the COVID-19 pandemic. Many physicians feel that communicating via telehealth is unlike traditional methods of providing health care, and thus guidance on maintaining excellence in communication is necessary, especially as academic literature on virtual care in surgery is nonexistent. Challenges faced in transitioning to virtual care include the inability to utilize body language, barriers to traditional physical examination, exacerbation of existing vulnerabilities and inequities in patient groups, the declining quality of medical education, and the fragmentation of the multidisciplinary health care team. This paper seeks to resolve these challenges by focusing on the pillars of good communication, including preparation, professionalism, empathy, respect, and the virtual physical examination.

covid-19 and virtual care;bioethics;consent;medical education;medical ethics;privacy;surgery;surgical communication;telehealth;telehealth in surgery;video care in surgery;virtual care;virtual care in surgery

Journal Article

Nemetz, Elisheva Tamar Anne;Urbach, David Robert;Devon, Karen Michelle

10.2196/22417

[Title]: The Art of Surgery: Balancing Compassionate With Virtual Care. [Abstract]: The recent drive to include virtual care in surgical practice has been accelerated due to the COVID-19 pandemic. Many physicians feel that communicating via telehealth is unlike traditional methods of providing health care, and thus guidance on maintaining excellence in communication is necessary, especially as academic literature on virtual care in surgery is nonexistent. Challenges faced in transitioning to virtual care include the inability to utilize body language, barriers to traditional physical examination, exacerbation of existing vulnerabilities and inequities in patient groups, the declining quality of medical education, and the fragmentation of the multidisciplinary health care team. This paper seeks to resolve these challenges by focusing on the pillars of good communication, including preparation, professionalism, empathy, respect, and the virtual physical examination. [Keywords]: covid-19 and virtual care;bioethics;consent;medical education;medical ethics;privacy;surgery;surgical communication;telehealth;telehealth in surgery;video care in surgery;virtual care;virtual care in surgery

JMIR Public Health Surveill

General Model for COVID-19 Spreading With Consideration of Intercity Migration, Insufficient Testing, and Active Intervention: Modeling Study of Pandemic Progression in Japan and the United States.

BACKGROUND: The coronavirus disease (COVID-19) began to spread in mid-December 2019 from Wuhan, China, to most provinces in China and over 200 other countries through an active travel network. Limited by the ability of the country or city to perform tests, the officially reported number of confirmed cases is expected to be much smaller than the true number of infected cases. OBJECTIVE: This study aims to develop a new susceptible-exposed-infected-confirmed-removed (SEICR) model for predicting the spreading progression of COVID-19 with consideration of intercity travel and the difference between the number of confirmed cases and actual infected cases, and to apply the model to provide a realistic prediction for the United States and Japan under different scenarios of active intervention. METHODS: The model introduces a new state variable corresponding to the actual number of infected cases, integrates intercity travel data to track the movement of exposed and infected individuals among cities, and allows different levels of active intervention to be considered so that a realistic prediction of the number of infected individuals can be performed. Moreover, the model generates future progression profiles for different levels of intervention by setting the parameters relative to the values found from the data fitting. RESULTS: By fitting the model with the data of the COVID-19 infection cases and the intercity travel data for Japan (January 15 to March 20, 2020) and the United States (February 20 to March 20, 2020), model parameters were found and then used to predict the pandemic progression in 47 regions of Japan and 50 states (plus a federal district) in the United States. The model revealed that, as of March 19, 2020, the number of infected individuals in Japan and the United States could be 20-fold and 5-fold as many as the number of confirmed cases, respectively. The results showed that, without tightening the implementation of active intervention, Japan and the United States will see about 6.55% and 18.2% of the population eventually infected, respectively, and with a drastic 10-fold elevated active intervention, the number of people eventually infected can be reduced by up to 95% in Japan and 70% in the United States. CONCLUSIONS: The new SEICR model has revealed the effectiveness of active intervention for controlling the spread of COVID-19. Stepping up active intervention would be more effective for Japan, and raising the level of public vigilance in maintaining personal hygiene and social distancing is comparatively more important for the United States.

covid-19;seicr model;effect of intervention;pandemic spreading;prediction

Journal Article;Research Support, Non-U.S. Gov't

Zhan, Choujun;Tse, Chi Kong;Lai, Zhikang;Chen, Xiaoyun;Mo, Mingshen

10.2196/18880

[Title]: General Model for COVID-19 Spreading With Consideration of Intercity Migration, Insufficient Testing, and Active Intervention: Modeling Study of Pandemic Progression in Japan and the United States. [Abstract]: BACKGROUND: The coronavirus disease (COVID-19) began to spread in mid-December 2019 from Wuhan, China, to most provinces in China and over 200 other countries through an active travel network. Limited by the ability of the country or city to perform tests, the officially reported number of confirmed cases is expected to be much smaller than the true number of infected cases. OBJECTIVE: This study aims to develop a new susceptible-exposed-infected-confirmed-removed (SEICR) model for predicting the spreading progression of COVID-19 with consideration of intercity travel and the difference between the number of confirmed cases and actual infected cases, and to apply the model to provide a realistic prediction for the United States and Japan under different scenarios of active intervention. METHODS: The model introduces a new state variable corresponding to the actual number of infected cases, integrates intercity travel data to track the movement of exposed and infected individuals among cities, and allows different levels of active intervention to be considered so that a realistic prediction of the number of infected individuals can be performed. Moreover, the model generates future progression profiles for different levels of intervention by setting the parameters relative to the values found from the data fitting. RESULTS: By fitting the model with the data of the COVID-19 infection cases and the intercity travel data for Japan (January 15 to March 20, 2020) and the United States (February 20 to March 20, 2020), model parameters were found and then used to predict the pandemic progression in 47 regions of Japan and 50 states (plus a federal district) in the United States. The model revealed that, as of March 19, 2020, the number of infected individuals in Japan and the United States could be 20-fold and 5-fold as many as the number of confirmed cases, respectively. The results showed that, without tightening the implementation of active intervention, Japan and the United States will see about 6.55% and 18.2% of the population eventually infected, respectively, and with a drastic 10-fold elevated active intervention, the number of people eventually infected can be reduced by up to 95% in Japan and 70% in the United States. CONCLUSIONS: The new SEICR model has revealed the effectiveness of active intervention for controlling the spread of COVID-19. Stepping up active intervention would be more effective for Japan, and raising the level of public vigilance in maintaining personal hygiene and social distancing is comparatively more important for the United States. [Keywords]: covid-19;seicr model;effect of intervention;pandemic spreading;prediction

Bull World Health Organ

Variant analysis of SARS-CoV-2 genomes.

Objective: To analyse genome variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods: Between 1 February and 1 May 2020, we downloaded 10 022 SARS CoV-2 genomes from four databases. The genomes were from infected patients in 68 countries. We identified variants by extracting pairwise alignment to the reference genome NC_045512, using the EMBOSS needle. Nucleotide variants in the coding regions were converted to corresponding encoded amino acid residues. For clade analysis, we used the open source software Bayesian evolutionary analysis by sampling trees, version 2.5. Findings: We identified 5775 distinct genome variants, including 2969 missense mutations, 1965 synonymous mutations, 484 mutations in the non-coding regions, 142 non-coding deletions, 100 in-frame deletions, 66 non-coding insertions, 36 stop-gained variants, 11 frameshift deletions and two in-frame insertions. The most common variants were the synonymous 3037C > T (6334 samples), P4715L in the open reading frame 1ab (6319 samples) and D614G in the spike protein (6294 samples). We identified six major clades, (that is, basal, D614G, L84S, L3606F, D448del and G392D) and 14 subclades. Regarding the base changes, the C > T mutation was the most common with 1670 distinct variants. Conclusion: We found that several variants of the SARS-CoV-2 genome exist and that the D614G clade has become the most common variant since December 2019. The evolutionary analysis indicated structured transmission, with the possibility of multiple introductions into the population.

Journal Article

Koyama, Takahiko;Platt, Daniel;Parida, Laxmi

10.2471/BLT.20.253591

[Title]: Variant analysis of SARS-CoV-2 genomes. [Abstract]: Objective: To analyse genome variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods: Between 1 February and 1 May 2020, we downloaded 10 022 SARS CoV-2 genomes from four databases. The genomes were from infected patients in 68 countries. We identified variants by extracting pairwise alignment to the reference genome NC_045512, using the EMBOSS needle. Nucleotide variants in the coding regions were converted to corresponding encoded amino acid residues. For clade analysis, we used the open source software Bayesian evolutionary analysis by sampling trees, version 2.5. Findings: We identified 5775 distinct genome variants, including 2969 missense mutations, 1965 synonymous mutations, 484 mutations in the non-coding regions, 142 non-coding deletions, 100 in-frame deletions, 66 non-coding insertions, 36 stop-gained variants, 11 frameshift deletions and two in-frame insertions. The most common variants were the synonymous 3037C > T (6334 samples), P4715L in the open reading frame 1ab (6319 samples) and D614G in the spike protein (6294 samples). We identified six major clades, (that is, basal, D614G, L84S, L3606F, D448del and G392D) and 14 subclades. Regarding the base changes, the C > T mutation was the most common with 1670 distinct variants. Conclusion: We found that several variants of the SARS-CoV-2 genome exist and that the D614G clade has become the most common variant since December 2019. The evolutionary analysis indicated structured transmission, with the possibility of multiple introductions into the population. [Keywords]:

Proc (Bayl Univ Med Cent)

SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread across the globe, and millions of people may be affected. While knowledge regarding epidemiologic features and diagnostic tools of coronavirus disease 2019 (COVID-19) is rapidly evolving, uncertainties surrounding various aspects of its optimal management strategies persist. A subset of these patients develop a more severe form of the disease characterized by expanding pulmonary lesions, sepsis, acute respiratory distress syndrome, and respiratory failure. Due to lack of data on treatment strategies specific to this subset of patients, currently available evidence on management of the critically ill needs to be extrapolated and customized to their clinical needs. The article calls attention to fluid stewardship in the critically ill with COVID-19 by judiciously applying the evidence-based resuscitation principles to their specific clinical features such as high rates of cardiac injury. As we await more data from treating these patients, this strategy is likely to help reduce potential complications.

covid-19;congestion;sars-cov-2;critically ill;resuscitation

Journal Article;Review

Kazory, Amir;Ronco, Claudio;McCullough, Peter A

10.1080/08998280.2020.1754700

[Title]: SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill. [Abstract]: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread across the globe, and millions of people may be affected. While knowledge regarding epidemiologic features and diagnostic tools of coronavirus disease 2019 (COVID-19) is rapidly evolving, uncertainties surrounding various aspects of its optimal management strategies persist. A subset of these patients develop a more severe form of the disease characterized by expanding pulmonary lesions, sepsis, acute respiratory distress syndrome, and respiratory failure. Due to lack of data on treatment strategies specific to this subset of patients, currently available evidence on management of the critically ill needs to be extrapolated and customized to their clinical needs. The article calls attention to fluid stewardship in the critically ill with COVID-19 by judiciously applying the evidence-based resuscitation principles to their specific clinical features such as high rates of cardiac injury. As we await more data from treating these patients, this strategy is likely to help reduce potential complications. [Keywords]: covid-19;congestion;sars-cov-2;critically ill;resuscitation

Transplantation

COVID-19 Outcomes Among Solid Organ Transplant Recipients: A Case-control Study.

BACKGROUND: Solid organ transplant (SOT) recipients are considered to be "vulnerable" to COVID-19 infection due to immunosuppression. To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with nontransplant patients. METHODS: In this case-control study, we compared the outcomes of COVID-19 between SOT recipients and their matched nontransplant controls. The cases were all adult SOT recipients (N = 41) from our academic health center who were diagnosed with COVID-19 between March 10, 2020 and May 15, 2020 using positive reverse transcriptase polymerase chain reaction for SARS-CoV2. The controls (N = 121) were matched on age (+/-5 y), race, and admission status (hospital or outpatient). The primary outcome was death and secondary outcomes were severe disease, intubation and renal replacement therapy (RRT). RESULTS: Median age of SOT recipients (9 heart, 3 lung, 16 kidney, 8 liver, and 5 dual organ) was 60 y, 80% were male and 67% were Black. Severe disease adjusted risk of death was similar in both the groups (hazard ratio = 0.84 [0.32-2.20]). Severity of COVID-19 and intubation were similar, but the RRT use was higher in SOT (odds ratio = 5.32 [1.26, 22.42]) compared to non-SOT COVID-19 patients. Among SOT recipients, COVID-19-related treatment with hydroxychloroquine (HCQ) was associated with 10-fold higher hazard of death compared to without HCQ (hazard ratio = 10.62 [1.24-91.09]). CONCLUSIONS: Although African Americans constituted one-tenth of all SOT in our center, they represented two-thirds of COVID-19 cases. Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups. HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny.

Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't

Sharma, Pratima;Chen, Vincent;Fung, Christopher M;Troost, Jonathan P;Patel, Vaiibhav N;Combs, Michael;Norman, Silas;Garg, Puneet;Colvin, Monica;Aaronson, Keith;Sonnenday, Christopher J;Golob, Jonathan L;Somers, Emily C;Doshi, Mona M

10.1097/TP.0000000000003447

[Title]: COVID-19 Outcomes Among Solid Organ Transplant Recipients: A Case-control Study. [Abstract]: BACKGROUND: Solid organ transplant (SOT) recipients are considered to be "vulnerable" to COVID-19 infection due to immunosuppression. To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with nontransplant patients. METHODS: In this case-control study, we compared the outcomes of COVID-19 between SOT recipients and their matched nontransplant controls. The cases were all adult SOT recipients (N = 41) from our academic health center who were diagnosed with COVID-19 between March 10, 2020 and May 15, 2020 using positive reverse transcriptase polymerase chain reaction for SARS-CoV2. The controls (N = 121) were matched on age (+/-5 y), race, and admission status (hospital or outpatient). The primary outcome was death and secondary outcomes were severe disease, intubation and renal replacement therapy (RRT). RESULTS: Median age of SOT recipients (9 heart, 3 lung, 16 kidney, 8 liver, and 5 dual organ) was 60 y, 80% were male and 67% were Black. Severe disease adjusted risk of death was similar in both the groups (hazard ratio = 0.84 [0.32-2.20]). Severity of COVID-19 and intubation were similar, but the RRT use was higher in SOT (odds ratio = 5.32 [1.26, 22.42]) compared to non-SOT COVID-19 patients. Among SOT recipients, COVID-19-related treatment with hydroxychloroquine (HCQ) was associated with 10-fold higher hazard of death compared to without HCQ (hazard ratio = 10.62 [1.24-91.09]). CONCLUSIONS: Although African Americans constituted one-tenth of all SOT in our center, they represented two-thirds of COVID-19 cases. Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups. HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny. [Keywords]:

Lancet

Fangcang shelter hospitals: a novel concept for responding to public health emergencies.

Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.

Journal Article;Research Support, Non-U.S. Gov't;Review

Chen, Simiao;Zhang, Zongjiu;Yang, Juntao;Wang, Jian;Zhai, Xiaohui;Barnighausen, Till;Wang, Chen

10.1016/S0140-6736(20)30744-3

[Title]: Fangcang shelter hospitals: a novel concept for responding to public health emergencies. [Abstract]: Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies. [Keywords]:

PLoS One

Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1mug/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. MATERIAL AND METHODS: Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 mug/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. RESULTS: Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p<0.001). CONCLUSIONS: Patients with COVID-19 pneumonia and D-dimer values higher than 1 mug/mL presented a high prevalence of PE, regardless of clinical suspicion. We consider that these findings could contribute to improve the prognosis of patients with COVID-19 pneumonia, by initiating anticoagulant therapy when a PE is found.

Journal Article

Alonso-Fernandez, Alberto;Toledo-Pons, Nuria;Cosio, Borja G;Millan, Aina;Calvo, Nestor;Ramon, Luisa;de Mendoza, Sara Hermoso;Morell-Garcia, Daniel;Bauca-Rossello, Josep Miquel;Nunez, Belen;Pons, Jaume;Palmer, Juan A;Martin, Luisa;Penaranda, Maria;Pou, Joan A;Sauleda, Jaume;Sala-Llinas, Ernest

10.1371/journal.pone.0238216

[Title]: Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study. [Abstract]: INTRODUCTION: Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1mug/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. MATERIAL AND METHODS: Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 mug/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. RESULTS: Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p<0.001). CONCLUSIONS: Patients with COVID-19 pneumonia and D-dimer values higher than 1 mug/mL presented a high prevalence of PE, regardless of clinical suspicion. We consider that these findings could contribute to improve the prognosis of patients with COVID-19 pneumonia, by initiating anticoagulant therapy when a PE is found. [Keywords]:

Stem Cell Res

SARS-CoV-2 infection and stem cells: Interaction and intervention.

The emergence of the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread have created a global health emergency. The resemblance with SARS-CoV in spike protein suggests that SARS-CoV-2 employs spike-driven entry into angiotensin-converting enzyme 2 (ACE2)-expressing cells. From a stem cell perspective, this review focuses on the possible involvement of ACE2(+) stem/progenitor cells from both the upper and lower respiratory tracts in coronavirus infection. Viral infection-associated acute respiratory distress syndrome and acute lung injury occur because of dysregulation of the immune response. Mesenchymal stem cells appear to be a promising cell therapy given that they favorably modulate the immune response to reduce lung injury. The use of exogenous stem cells may lead to lung repair. Therefore, intervention by transplantation of exogenous stem cells may be required to replace, repair, remodel, and regenerate lung tissue in survivors infected with coronavirus. Ultimately, vaccines, natural killer cells and induced-pluripotent stem cell-derived virus-specific cytotoxic T lymphocytes may offer off-the-shelf therapeutics for preventing coronavirus reemergence.

immunomodulation;infection;repair;severe acute respiratory coronavirus 2;stem cells

Journal Article;Review

Yu, Fenggang;Jia, Rufu;Tang, Yongyong;Liu, Jin;Wei, Benjie

10.1016/j.scr.2020.101859

[Title]: SARS-CoV-2 infection and stem cells: Interaction and intervention. [Abstract]: The emergence of the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread have created a global health emergency. The resemblance with SARS-CoV in spike protein suggests that SARS-CoV-2 employs spike-driven entry into angiotensin-converting enzyme 2 (ACE2)-expressing cells. From a stem cell perspective, this review focuses on the possible involvement of ACE2(+) stem/progenitor cells from both the upper and lower respiratory tracts in coronavirus infection. Viral infection-associated acute respiratory distress syndrome and acute lung injury occur because of dysregulation of the immune response. Mesenchymal stem cells appear to be a promising cell therapy given that they favorably modulate the immune response to reduce lung injury. The use of exogenous stem cells may lead to lung repair. Therefore, intervention by transplantation of exogenous stem cells may be required to replace, repair, remodel, and regenerate lung tissue in survivors infected with coronavirus. Ultimately, vaccines, natural killer cells and induced-pluripotent stem cell-derived virus-specific cytotoxic T lymphocytes may offer off-the-shelf therapeutics for preventing coronavirus reemergence. [Keywords]: immunomodulation;infection;repair;severe acute respiratory coronavirus 2;stem cells

Ther Adv Musculoskelet Dis

Impact of COVID-19 on orthopaedic care: a call for nonoperative management.

Background: Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods: A systematic search was conducted, and included guidance were categorized as either "Selective Postponement" or "Complete Postponement" of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results: A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion: Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.

covid-19;nonoperative treatment;pandemic;surgery

Journal Article;Review

Phillips, Mark R;Chang, Yaping;Zura, Robert D;Mehta, Samir;Giannoudis, Peter V;Nolte, Peter A;Bhandari, Mohit

10.1177/1759720X20934276

[Title]: Impact of COVID-19 on orthopaedic care: a call for nonoperative management. [Abstract]: Background: Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods: A systematic search was conducted, and included guidance were categorized as either "Selective Postponement" or "Complete Postponement" of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results: A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion: Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns. [Keywords]: covid-19;nonoperative treatment;pandemic;surgery

SN Compr Clin Med

Navigating the Diagnostics of COVID-19.

The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Hubei province, China, in December 2019 and has spread worldwide at an alarming rate. With over eight million individuals infected and exceeding 400,000 deaths globally, the necessity to develop fast and efficient diagnostic methods is of high importance. This paper reports on currently available diagnostic screening methods for patients infected with SARS-CoV-2 to guide frontline healthcare workers involved with the diagnosis of 2019 novel coronavirus disease (COVID-19) patient. An electronic literature search was performed for peer-reviewed articles published from January 1, 2020, until June 19, 2020. Published articles were then reviewed and included based on the applicability to the topic. The preferred diagnostic approach is the reverse transcription (RT) of the virus' ribonucleic acid (RNA) followed by polymerase chain reaction (PCR) amplification (RT-PCR). However, this method has been proven to be time-consuming. In improving the speed and efficiency of diagnostics, newer rapid diagnostic serological tests are in development for testing SARS-CoV-2, each with its unique advantages and disadvantages. They could potentially be used as triage tests to rapidly identify patients who are very likely to have COVID-19 in combination with other accurate diagnostic methods, such as diagnostic imaging. A combination of the disease history, clinical manifestations, laboratory diagnostic testing, and diagnostic imaging is crucial for making an accurate and useful diagnosis for COVID-19. Hopefully, the continuous development and use of rapid diagnostic tests and the implementation of public health measures will help control the spread of the disease.

covid-19;diagnostic test;rt-pcr;sars-cov-2;serology

Journal Article;Review

Sanyaolu, Adekunle;Okorie, Chuku;Marinkovic, Aleksandra;Ayodele, Oladapo;Abbasi, Abu Fahad;Prakash, Stephanie;Ahmed, Miriam;Kayode, Damilare;Jaferi, Urooj;Haider, Nafees

10.1007/s42399-020-00408-8

[Title]: Navigating the Diagnostics of COVID-19. [Abstract]: The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Hubei province, China, in December 2019 and has spread worldwide at an alarming rate. With over eight million individuals infected and exceeding 400,000 deaths globally, the necessity to develop fast and efficient diagnostic methods is of high importance. This paper reports on currently available diagnostic screening methods for patients infected with SARS-CoV-2 to guide frontline healthcare workers involved with the diagnosis of 2019 novel coronavirus disease (COVID-19) patient. An electronic literature search was performed for peer-reviewed articles published from January 1, 2020, until June 19, 2020. Published articles were then reviewed and included based on the applicability to the topic. The preferred diagnostic approach is the reverse transcription (RT) of the virus' ribonucleic acid (RNA) followed by polymerase chain reaction (PCR) amplification (RT-PCR). However, this method has been proven to be time-consuming. In improving the speed and efficiency of diagnostics, newer rapid diagnostic serological tests are in development for testing SARS-CoV-2, each with its unique advantages and disadvantages. They could potentially be used as triage tests to rapidly identify patients who are very likely to have COVID-19 in combination with other accurate diagnostic methods, such as diagnostic imaging. A combination of the disease history, clinical manifestations, laboratory diagnostic testing, and diagnostic imaging is crucial for making an accurate and useful diagnosis for COVID-19. Hopefully, the continuous development and use of rapid diagnostic tests and the implementation of public health measures will help control the spread of the disease. [Keywords]: covid-19;diagnostic test;rt-pcr;sars-cov-2;serology

Zhonghua Jie He He Hu Xi Za Zhi

[Clinical characteristics and death risk factors of severe COVID-19].

Objective: To analyze the clinical features and death-related risk factors of COVID-19. Methods: We enrolled 891 COVID-19 patients admitted to the Affiliated Hospital of Jianghan University from December 2019 to February 2020, including 427 men and 464 women. Of the 891 cases, 582 were severe or critical, including 423(73%)severe and 159 (27%) critical cases. We compared the demographics, laboratory findings, clinical characteristics, treatments and prognosis data of the 582 severe patients. Univariate and multivariate logistic regression analysis was conducted to explore the risk factors associated with death in COVID-19 patients. Results: The 582 severe patients included 293 males and 289 females, with a median age of 64(range 24 to 106). Sixty-three patients died, including 45 males and 18 females, with a median age of 71(range 37 to 90). The average onset time of the 582 patients was 8 days, of whom 461 (79%) had fever, 358 (62%) dry cough, 274 (47%) fatigue. There were 206 cases with shortness of breath (35%), 155 cases with expectoration (27%), 83 cases with muscle pain or joint pain (14%), 71 cases with diarrhea (12%), and 29 cases with headache (4%). Underlying diseases were present in 267 (46%) patients, most commonly hypertension (194, 33%), followed by diabetes (69, 12%), coronary atherosclerotic heart disease (37, 6%), tumor (18, 3%), and chronic obstructive pulmonary disease (5, 1%). Chest CT showed bilateral lung involvement in 505 patients (87%). Upon admission, the median lymphocyte count of the 582 patients was 0.8(IQR, 0.6-1.1)x10(9)/L, the median D-dimer was 0.5 (IQR, 0.4- 0.8) mg/L, the median N-terminal brain natriuretic peptide precursor (NT-proBNP) was 433 (IQR, 141- 806) pg/L, and the median creatinine was 70.3 (IQR, 56.9-87.9) mumol/L. The death group had a median lymphocyte count of 0.5 (0.4-0.8)x10(9)/L, D-dimer 1.1 (0.7-10.0)mg/L, N-terminal brain natriuretic peptide precursor 1479(893-5 087) pg/ml, and creatinine 89.9(67.1-125.3) mumol/L. Multivariate logistic analysis showed that increased D-dimer (OR: 1.095, 95% CI: 1.045-1.148, P<0.001), increased NT-proBNP (OR: 4.759, 95% CI: 2.437-9.291, P<0.001), and decreased lymphocyte count (OR: 0.180, 95% CI: 0.059-0.550, P=0.003) were the risk factors of death in COVID-19 patients. Conclusions: The average onset time of severe COVID-19 was 8 days, and the most common symptoms were fever, dry cough and fatigue. Comorbidities such as hypertension were common and mostly accompanied by impaired organ functions on admission. Higher D-dimer, higher NT-proBNP, and lower lymphocyte count were the independent risk factors of death in COVID-19 patients.

covid-19;clinical characteristics;cohort studies;risk factors

Journal Article

Qin, W;Hu, B Z;Zhang, Z;Chen, S;Li, F J;Zhu, Z Y;Wang, X J;Liu, M;Li, C H

10.3760/cma.j.cn112147-20200320-00380

[Title]: [Clinical characteristics and death risk factors of severe COVID-19]. [Abstract]: Objective: To analyze the clinical features and death-related risk factors of COVID-19. Methods: We enrolled 891 COVID-19 patients admitted to the Affiliated Hospital of Jianghan University from December 2019 to February 2020, including 427 men and 464 women. Of the 891 cases, 582 were severe or critical, including 423(73%)severe and 159 (27%) critical cases. We compared the demographics, laboratory findings, clinical characteristics, treatments and prognosis data of the 582 severe patients. Univariate and multivariate logistic regression analysis was conducted to explore the risk factors associated with death in COVID-19 patients. Results: The 582 severe patients included 293 males and 289 females, with a median age of 64(range 24 to 106). Sixty-three patients died, including 45 males and 18 females, with a median age of 71(range 37 to 90). The average onset time of the 582 patients was 8 days, of whom 461 (79%) had fever, 358 (62%) dry cough, 274 (47%) fatigue. There were 206 cases with shortness of breath (35%), 155 cases with expectoration (27%), 83 cases with muscle pain or joint pain (14%), 71 cases with diarrhea (12%), and 29 cases with headache (4%). Underlying diseases were present in 267 (46%) patients, most commonly hypertension (194, 33%), followed by diabetes (69, 12%), coronary atherosclerotic heart disease (37, 6%), tumor (18, 3%), and chronic obstructive pulmonary disease (5, 1%). Chest CT showed bilateral lung involvement in 505 patients (87%). Upon admission, the median lymphocyte count of the 582 patients was 0.8(IQR, 0.6-1.1)x10(9)/L, the median D-dimer was 0.5 (IQR, 0.4- 0.8) mg/L, the median N-terminal brain natriuretic peptide precursor (NT-proBNP) was 433 (IQR, 141- 806) pg/L, and the median creatinine was 70.3 (IQR, 56.9-87.9) mumol/L. The death group had a median lymphocyte count of 0.5 (0.4-0.8)x10(9)/L, D-dimer 1.1 (0.7-10.0)mg/L, N-terminal brain natriuretic peptide precursor 1479(893-5 087) pg/ml, and creatinine 89.9(67.1-125.3) mumol/L. Multivariate logistic analysis showed that increased D-dimer (OR: 1.095, 95% CI: 1.045-1.148, P<0.001), increased NT-proBNP (OR: 4.759, 95% CI: 2.437-9.291, P<0.001), and decreased lymphocyte count (OR: 0.180, 95% CI: 0.059-0.550, P=0.003) were the risk factors of death in COVID-19 patients. Conclusions: The average onset time of severe COVID-19 was 8 days, and the most common symptoms were fever, dry cough and fatigue. Comorbidities such as hypertension were common and mostly accompanied by impaired organ functions on admission. Higher D-dimer, higher NT-proBNP, and lower lymphocyte count were the independent risk factors of death in COVID-19 patients. [Keywords]: covid-19;clinical characteristics;cohort studies;risk factors

Cell Biochem Funct

Potential small-molecule drugs as available weapons to fight novel coronavirus (2019-nCoV): A review.

Since the new coronavirus known as 2019-nCoV (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has widely spread in Wuhan, China, with severe pneumonia, scientists and physicians have made remarkable efforts to use various options such as monoclonal antibodies, peptides, vaccines, small-molecule drugs and interferon therapies to control, prevent or treatment infections of 2019-nCoV. However, no vaccine or drug has yet been confirmed to completely treat 2019-nCoV. In this review, we focus on the use of potential available small-molecule drug candidates for treating infections caused by 2019-nCoV.

2019-ncov;infection;small-molecule drugs

Journal Article;Review

Rahimkhoei, Vahid;Jabbari, Nassrollah;Nourani, Aynaz;Sharifi, Sina;Akbari, Ali

10.1002/cbf.3576

[Title]: Potential small-molecule drugs as available weapons to fight novel coronavirus (2019-nCoV): A review. [Abstract]: Since the new coronavirus known as 2019-nCoV (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has widely spread in Wuhan, China, with severe pneumonia, scientists and physicians have made remarkable efforts to use various options such as monoclonal antibodies, peptides, vaccines, small-molecule drugs and interferon therapies to control, prevent or treatment infections of 2019-nCoV. However, no vaccine or drug has yet been confirmed to completely treat 2019-nCoV. In this review, we focus on the use of potential available small-molecule drug candidates for treating infections caused by 2019-nCoV. [Keywords]: 2019-ncov;infection;small-molecule drugs

Sensors (Basel)

What Features and Functions Are Desired in Telemedical Services Targeted at Polish Older Adults Delivered by Wearable Medical Devices?-Pre-COVID-19 Flashback.

The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: >/=65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices.

assisted living technologies;gerontechnology;health monitoring system;telemedical services;wearable

Journal Article

Kantoch, Eliasz;Kantoch, Anna

10.3390/s20185181

[Title]: What Features and Functions Are Desired in Telemedical Services Targeted at Polish Older Adults Delivered by Wearable Medical Devices?-Pre-COVID-19 Flashback. [Abstract]: The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: >/=65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices. [Keywords]: assisted living technologies;gerontechnology;health monitoring system;telemedical services;wearable

J Infect Dev Ctries

Tuberculosis and COVID-19: An overlapping situation during pandemic.

INTRODUCTION: The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19). First COVID-19 case was detected in March, 10, 2020 in Turkey and as of May, 18, 2020 148,067 cases have been identified and 4096 citizens have died. Tuberculosis (TB) is a worldwide public health concern, incidence of tuberculosis (per 100,000 people) in Turkey was reported at 14, 1 in 2018. During pandemic COVID-19 was the main concern in every clinic and as we discuss here overlapping respiratory diseases may result in delaying of the diagnosis and treatment. METHODOLOGY: There were 4605 respiratory samples examined between March 23 and May 18 for COVID-19 and 185 samples for Mycobacterium tuberculosis in our laboratory. The Xpert Ultra assay was performed for the diagnosis of pulmonary tuberculosis; SARS-CoV-2 RNA was determined by real-time PCR (RT-PCR) analysis in combined nasopharyngeal and deep oropharyngeal swabs of suspected cases of COVID-19. RESULTS: Both of SARS-CoV-2 and M. tuberculosis tests were requested on the clinical and radiological grounds in 30 patients. Here we discussed 2 patients who were both COVID-19 and TB positive. One patient already diagnosed with tuberculosis become COVID-19 positive during hospitalization and another patient suspected and treated for COVID-19 received the final diagnosis of pulmonary TB and Human Immunodeficiency Virus infection. CONCLUSIONS: We want to emphasize that while considering COVID-19 primarily during these pandemic days, we should not forget one of the "great imitators", tuberculosis within differential diagnoses.

covid-19;mycobacterium tuberculosis;pcr;sars-cov-2;tuberculosis

Journal Article

Can Sarinoglu, Rabia;Sili, Uluhan;Eryuksel, Emel;Olgun Yildizeli, Sehnaz;Cimsit, Cagatay;Karahasan Yagci, Aysegul

10.3855/jidc.13152

[Title]: Tuberculosis and COVID-19: An overlapping situation during pandemic. [Abstract]: INTRODUCTION: The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19). First COVID-19 case was detected in March, 10, 2020 in Turkey and as of May, 18, 2020 148,067 cases have been identified and 4096 citizens have died. Tuberculosis (TB) is a worldwide public health concern, incidence of tuberculosis (per 100,000 people) in Turkey was reported at 14, 1 in 2018. During pandemic COVID-19 was the main concern in every clinic and as we discuss here overlapping respiratory diseases may result in delaying of the diagnosis and treatment. METHODOLOGY: There were 4605 respiratory samples examined between March 23 and May 18 for COVID-19 and 185 samples for Mycobacterium tuberculosis in our laboratory. The Xpert Ultra assay was performed for the diagnosis of pulmonary tuberculosis; SARS-CoV-2 RNA was determined by real-time PCR (RT-PCR) analysis in combined nasopharyngeal and deep oropharyngeal swabs of suspected cases of COVID-19. RESULTS: Both of SARS-CoV-2 and M. tuberculosis tests were requested on the clinical and radiological grounds in 30 patients. Here we discussed 2 patients who were both COVID-19 and TB positive. One patient already diagnosed with tuberculosis become COVID-19 positive during hospitalization and another patient suspected and treated for COVID-19 received the final diagnosis of pulmonary TB and Human Immunodeficiency Virus infection. CONCLUSIONS: We want to emphasize that while considering COVID-19 primarily during these pandemic days, we should not forget one of the "great imitators", tuberculosis within differential diagnoses. [Keywords]: covid-19;mycobacterium tuberculosis;pcr;sars-cov-2;tuberculosis

J Proteome Res

Repurposing of FDA-Approved Toremifene to Treat COVID-19 by Blocking the Spike Glycoprotein and NSP14 of SARS-CoV-2.

The global pandemic of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to the death of more than 675,000 worldwide and over 150,000 in the United States alone. However, there are currently no approved effective pharmacotherapies for COVID-19. Here, we combine homology modeling, molecular docking, molecular dynamics simulation, and binding affinity calculations to determine potential targets for toremifene, a selective estrogen receptor modulator which we have previously identified as a SARS-CoV-2 inhibitor. Our results indicate the possibility of inhibition of the spike glycoprotein by toremifene, responsible for aiding in fusion of the viral membrane with the cell membrane, via a perturbation to the fusion core. An interaction between the dimethylamine end of toremifene and residues Q954 and N955 in heptad repeat 1 (HR1) perturbs the structure, causing a shift from what is normally a long, helical region to short helices connected by unstructured regions. Additionally, we found a strong interaction between toremifene and the methyltransferase nonstructural protein (NSP) 14, which could be inhibitory to viral replication via its active site. These results suggest potential structural mechanisms for toremifene by blocking the spike protein and NSP14 of SARS-CoV-2, offering a drug candidate for COVID-19.

covid-19;sars-cov-2;drug repurposing;methyltransferase nonstructural protein 14 (nsp14);molecular docking;spike glycoprotein;toremifene

Journal Article;Research Support, N.I.H., Extramural

Martin, William R;Cheng, Feixiong

10.1021/acs.jproteome.0c00397

[Title]: Repurposing of FDA-Approved Toremifene to Treat COVID-19 by Blocking the Spike Glycoprotein and NSP14 of SARS-CoV-2. [Abstract]: The global pandemic of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to the death of more than 675,000 worldwide and over 150,000 in the United States alone. However, there are currently no approved effective pharmacotherapies for COVID-19. Here, we combine homology modeling, molecular docking, molecular dynamics simulation, and binding affinity calculations to determine potential targets for toremifene, a selective estrogen receptor modulator which we have previously identified as a SARS-CoV-2 inhibitor. Our results indicate the possibility of inhibition of the spike glycoprotein by toremifene, responsible for aiding in fusion of the viral membrane with the cell membrane, via a perturbation to the fusion core. An interaction between the dimethylamine end of toremifene and residues Q954 and N955 in heptad repeat 1 (HR1) perturbs the structure, causing a shift from what is normally a long, helical region to short helices connected by unstructured regions. Additionally, we found a strong interaction between toremifene and the methyltransferase nonstructural protein (NSP) 14, which could be inhibitory to viral replication via its active site. These results suggest potential structural mechanisms for toremifene by blocking the spike protein and NSP14 of SARS-CoV-2, offering a drug candidate for COVID-19. [Keywords]: covid-19;sars-cov-2;drug repurposing;methyltransferase nonstructural protein 14 (nsp14);molecular docking;spike glycoprotein;toremifene

J Clin Med

Could Mesenchymal Stem Cell-Derived Exosomes Be a Therapeutic Option for Critically Ill COVID-19 Patients?

Coronavirus disease 2019 (COVID-19) is a pandemic viral disease originated in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severe form of the disease is often associated with acute respiratory distress syndrome (ARDS), and most critically ill patients require mechanical ventilation and support in intensive care units. A significant portion of COVID-19 patients also develop complications of the cardiovascular system, primarily acute myocardial injury, arrhythmia, or heart failure. To date, no specific antiviral therapy is available for patients with SARS-CoV-2 infection. Exosomes derived from mesenchymal stem cells (MSCs) are being explored for the management of a number of diseases that currently have limited or no therapeutic options, thanks to their anti-inflammatory, immunomodulatory, and pro-angiogenic properties. Here, we briefly introduce the pathogenesis of SARS-CoV-2 and its implications in the heart and lungs. Next, we describe some of the most significant clinical evidence of the successful use of MSC-derived exosomes in animal models of lung and heart injuries, which might strengthen our hypothesis in terms of their utility for also treating critically ill COVID-19 patients.

covid-19;acute lung injury;acute myocardial injury;angiotensin-converting enzyme 2;anti-inflammation;coronavirus;immunomodulation;mesenchymal stem cell-derived exosomes

Journal Article;Review

Gardin, Chiara;Ferroni, Letizia;Chachques, Juan Carlos;Zavan, Barbara

10.3390/jcm9092762

[Title]: Could Mesenchymal Stem Cell-Derived Exosomes Be a Therapeutic Option for Critically Ill COVID-19 Patients? [Abstract]: Coronavirus disease 2019 (COVID-19) is a pandemic viral disease originated in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severe form of the disease is often associated with acute respiratory distress syndrome (ARDS), and most critically ill patients require mechanical ventilation and support in intensive care units. A significant portion of COVID-19 patients also develop complications of the cardiovascular system, primarily acute myocardial injury, arrhythmia, or heart failure. To date, no specific antiviral therapy is available for patients with SARS-CoV-2 infection. Exosomes derived from mesenchymal stem cells (MSCs) are being explored for the management of a number of diseases that currently have limited or no therapeutic options, thanks to their anti-inflammatory, immunomodulatory, and pro-angiogenic properties. Here, we briefly introduce the pathogenesis of SARS-CoV-2 and its implications in the heart and lungs. Next, we describe some of the most significant clinical evidence of the successful use of MSC-derived exosomes in animal models of lung and heart injuries, which might strengthen our hypothesis in terms of their utility for also treating critically ill COVID-19 patients. [Keywords]: covid-19;acute lung injury;acute myocardial injury;angiotensin-converting enzyme 2;anti-inflammation;coronavirus;immunomodulation;mesenchymal stem cell-derived exosomes

Eurasian J Med

Atypical Presentation of COVID-19: Acute Renal Failure.

Coronavirus disease (COVID-19) emerged in Wuhan, China, in December 2019 and rapidly became a global pandemic, with the number of confirmed infections worldwide reaching 1 million by the start of April 2020 and 3 million less than a month later. COVID-19 can be encountered with different clinical presentations. We present the case of a patient with COVID-19 in the etiology presenting with acute renal failure.

acute renal failure;sars-cov-2;acute respiratuary distress syndrome

Journal Article

Kerget, Bugra;Akgun, Metin;Dogan, Nazim

10.5152/eurasianjmed.2020.20134

[Title]: Atypical Presentation of COVID-19: Acute Renal Failure. [Abstract]: Coronavirus disease (COVID-19) emerged in Wuhan, China, in December 2019 and rapidly became a global pandemic, with the number of confirmed infections worldwide reaching 1 million by the start of April 2020 and 3 million less than a month later. COVID-19 can be encountered with different clinical presentations. We present the case of a patient with COVID-19 in the etiology presenting with acute renal failure. [Keywords]: acute renal failure;sars-cov-2;acute respiratuary distress syndrome

Infect Dis Model

Generalized logistic growth modeling of the COVID-19 pandemic in Asia.

Several months into the ongoing novel coronavirus disease 2019 (COVID-19) pandemic, this work provides a simple and direct projection of the outbreak spreading potential and the pandemic cessation dates in Chinese mainland, Iran, the Philippines and Chinese Taiwan, using the generalized logistic model (GLM). The short-term predicted number of cumulative COVID-19 cases matched the confirmed reports of those who were infected across the four countries and regions, and the long-term forecasts were capable to accurately evaluate the spread of the pandemic in Chinese mainland and Chinese Taiwan, where control measures such as social distancing were fully implemented and sustained, suggesting GLM as a valuable tool for characterizing the transmission dynamics process and the trajectory of COVID-19 pandemic along with the impact of interventions.

covid-19;epidemic modeling;forecasting;generalized logistic model;richards model;sars-cov-2

Journal Article

Aviv-Sharon, Elinor;Aharoni, Asaph

10.1016/j.idm.2020.07.003

[Title]: Generalized logistic growth modeling of the COVID-19 pandemic in Asia. [Abstract]: Several months into the ongoing novel coronavirus disease 2019 (COVID-19) pandemic, this work provides a simple and direct projection of the outbreak spreading potential and the pandemic cessation dates in Chinese mainland, Iran, the Philippines and Chinese Taiwan, using the generalized logistic model (GLM). The short-term predicted number of cumulative COVID-19 cases matched the confirmed reports of those who were infected across the four countries and regions, and the long-term forecasts were capable to accurately evaluate the spread of the pandemic in Chinese mainland and Chinese Taiwan, where control measures such as social distancing were fully implemented and sustained, suggesting GLM as a valuable tool for characterizing the transmission dynamics process and the trajectory of COVID-19 pandemic along with the impact of interventions. [Keywords]: covid-19;epidemic modeling;forecasting;generalized logistic model;richards model;sars-cov-2

Med Teach

Adapting to the impact of COVID-19: Sharing stories, sharing practice.

Health Professions' Educators (HPEs) and their learners have to adapt their educational provision to rapidly changing and uncertain circumstances linked to the COVID-19 pandemic. This paper reports on an AMEE-hosted webinar: Adapting to the impact of COVID-19: Sharing stories, sharing practice. Attended by over 500 colleagues from five continents, this webinar focused on the impact of the virus across the continuum of education and training. Short formal presentations on teaching and learning, assessment, selection and postgraduate training generated wide-ranging questions via the Chatbox. A thematic analysis of the Chatbox thread indicated the most pressing concerns and challenges educators were experiencing in having to adapt programmes and learning across the continuum of medical education and training. The main areas of concern were: campus-based teaching and learning; clinical teaching; selection and assessment, and educator needs. While there is clearly no one simple solution to the unprecedented issues medical education and training face currently, there were two over-arching messages. First, this is a time for colleagues across the globe to help and support each other. Second, many local responses and innovations could have the potential to change the shape of medical education and training in the future.

covid-19;assessment;change;innovation;pandemic;resilience;selection;teaching and learning;technology;workplace learning

Journal Article

Cleland, Jennifer;McKimm, Judy;Fuller, Richard;Taylor, David;Janczukowicz, Janusz;Gibbs, Trevor

10.1080/0142159X.2020.1757635

[Title]: Adapting to the impact of COVID-19: Sharing stories, sharing practice. [Abstract]: Health Professions' Educators (HPEs) and their learners have to adapt their educational provision to rapidly changing and uncertain circumstances linked to the COVID-19 pandemic. This paper reports on an AMEE-hosted webinar: Adapting to the impact of COVID-19: Sharing stories, sharing practice. Attended by over 500 colleagues from five continents, this webinar focused on the impact of the virus across the continuum of education and training. Short formal presentations on teaching and learning, assessment, selection and postgraduate training generated wide-ranging questions via the Chatbox. A thematic analysis of the Chatbox thread indicated the most pressing concerns and challenges educators were experiencing in having to adapt programmes and learning across the continuum of medical education and training. The main areas of concern were: campus-based teaching and learning; clinical teaching; selection and assessment, and educator needs. While there is clearly no one simple solution to the unprecedented issues medical education and training face currently, there were two over-arching messages. First, this is a time for colleagues across the globe to help and support each other. Second, many local responses and innovations could have the potential to change the shape of medical education and training in the future. [Keywords]: covid-19;assessment;change;innovation;pandemic;resilience;selection;teaching and learning;technology;workplace learning

Can Assoc Radiol J

The Role of Emergency Radiology in COVID-19: From Preparedness to Diagnosis [Formula: see text].

Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership and taking the lead in the preparedness of imaging departments in dealing with novel highly infectious communicable diseases and mass casualties. This has become even more apparent in dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology departments, and emergency radiology departments can play in the diagnosis of this disease. We review practical methods to reduce spread of infections within radiology departments.

covid-19;ct;mers;sars;emergency and trauma radiology;preparedness

Journal Article;Review

Nasir, Muhammad Umer;Roberts, James;Muller, Nestor L;Macri, Francesco;Mohammed, Mohammed F;Akhlaghpoor, Shahram;Parker, William;Eftekhari, Arash;Rezaei, Susan;Mayo, John;Nicolaou, Savvas

10.1177/0846537120916419

[Title]: The Role of Emergency Radiology in COVID-19: From Preparedness to Diagnosis [Formula: see text]. [Abstract]: Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership and taking the lead in the preparedness of imaging departments in dealing with novel highly infectious communicable diseases and mass casualties. This has become even more apparent in dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology departments, and emergency radiology departments can play in the diagnosis of this disease. We review practical methods to reduce spread of infections within radiology departments. [Keywords]: covid-19;ct;mers;sars;emergency and trauma radiology;preparedness

Cell

Elevated Calprotectin and Abnormal Myeloid Cell Subsets Discriminate Severe from Mild COVID-19.

Blood myeloid cells are known to be dysregulated in coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2. It is unknown whether the innate myeloid response differs with disease severity and whether markers of innate immunity discriminate high-risk patients. Thus, we performed high-dimensional flow cytometry and single-cell RNA sequencing of COVID-19 patient peripheral blood cells and detected disappearance of non-classical CD14(Low)CD16(High) monocytes, accumulation of HLA-DR(Low) classical monocytes (Human Leukocyte Antigen - DR isotype), and release of massive amounts of calprotectin (S100A8/S100A9) in severe cases. Immature CD10(Low)CD101(-)CXCR4(+/-) neutrophils with an immunosuppressive profile accumulated in the blood and lungs, suggesting emergency myelopoiesis. Finally, we show that calprotectin plasma level and a routine flow cytometry assay detecting decreased frequencies of non-classical monocytes could discriminate patients who develop a severe form of COVID-19, suggesting a predictive value that deserves prospective evaluation.

covid-19;s100a8;s100a9;sars-cov-2;calprotectin;emergency myelopoiesis;monocyte subsets;neutrophils;type i interferon

Journal Article

Silvin, Aymeric;Chapuis, Nicolas;Dunsmore, Garett;Goubet, Anne-Gaelle;Dubuisson, Agathe;Derosa, Lisa;Almire, Carole;Henon, Clemence;Kosmider, Olivier;Droin, Nathalie;Rameau, Philippe;Catelain, Cyril;Alfaro, Alexia;Dussiau, Charles;Friedrich, Chloe;Sourdeau, Elise;Marin, Nathalie;Szwebel, Tali-Anne;Cantin, Delphine;Mouthon, Luc;Borderie, Didier;Deloger, Marc;Bredel, Delphine;Mouraud, Severine;Drubay, Damien;Andrieu, Muriel;Lhonneur, Anne-Sophie;Saada, Veronique;Stoclin, Annabelle;Willekens, Christophe;Pommeret, Fanny;Griscelli, Frank;Ng, Lai Guan;Zhang, Zheng;Bost, Pierre;Amit, Ido;Barlesi, Fabrice;Marabelle, Aurelien;Pene, Frederic;Gachot, Bertrand;Andre, Fabrice;Zitvogel, Laurence;Ginhoux, Florent;Fontenay, Michaela;Solary, Eric

10.1016/j.cell.2020.08.002

[Title]: Elevated Calprotectin and Abnormal Myeloid Cell Subsets Discriminate Severe from Mild COVID-19. [Abstract]: Blood myeloid cells are known to be dysregulated in coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2. It is unknown whether the innate myeloid response differs with disease severity and whether markers of innate immunity discriminate high-risk patients. Thus, we performed high-dimensional flow cytometry and single-cell RNA sequencing of COVID-19 patient peripheral blood cells and detected disappearance of non-classical CD14(Low)CD16(High) monocytes, accumulation of HLA-DR(Low) classical monocytes (Human Leukocyte Antigen - DR isotype), and release of massive amounts of calprotectin (S100A8/S100A9) in severe cases. Immature CD10(Low)CD101(-)CXCR4(+/-) neutrophils with an immunosuppressive profile accumulated in the blood and lungs, suggesting emergency myelopoiesis. Finally, we show that calprotectin plasma level and a routine flow cytometry assay detecting decreased frequencies of non-classical monocytes could discriminate patients who develop a severe form of COVID-19, suggesting a predictive value that deserves prospective evaluation. [Keywords]: covid-19;s100a8;s100a9;sars-cov-2;calprotectin;emergency myelopoiesis;monocyte subsets;neutrophils;type i interferon

Genes Environ

Mutagenic, Genotoxic and Immunomodulatory effects of Hydroxychloroquine and Chloroquine: a review to evaluate its potential to use as a prophylactic drug against COVID-19.

Hydroxychloroquine (HCQ) and Chloroquine (CQ) are two anti-malarial drugs that are now being extensively used by front-line healthcare workers and other common people as a prophylactic drug against the Corona Virus Disease - 19 (COVID-19) in India and as well as in many parts of the world. While only a few in vitro studies have pointed to some efficacy of these drugs as a prophylactic against COVID-19, to date, there are no clinical studies that have established any clinical efficacy of these drugs as a prophylactic. These drugs are commonly used for the treatment of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) because of its immunomodulatory effects. Previously, we have evaluated the genetic toxicology of different drugs and chemicals including antimalarial drug CQ both in vitro and in vivo. Thus, we recognize the need to critically review the mutagenic, genotoxic, and immunomodulatory effects of these drugs, to find out whether it is safe to use as a prophylactic drug against COVID-19. Existing literature suggests that CQ can induce mutagenic and genotoxic effects in multiple test systems and both the drugs have immunomodulatory effects. There was no data available to evaluate the mutagenicity and genotoxicity for HCQ. However, during metabolism about 60% of both the drugs remain unchanged and about 40% of the drugs are metabolized into two metabolites, desethylchloroquine and bisdesethylchloroquine by the action of the cytochrome P450 (CYP) enzymes in the liver. Both HCQ and CQ are immunomodulatory drugs and have the potential to suppress normal immune system activation. In this review, we have elucidated the mechanism of immunomodulation by both HCQ and CQ and highlighted the mutagenic and genotoxic effects from the available literature. This article is written with the sole objective that the reader will be able to recognize the adverse effects of these drugs when consumed by healthy individuals as a prophylactic. Current literature indicates that healthy individuals should refrain from the use of these drugs until further investigation.

covid-19;chloroquine;genotoxicity;hydroxychloroquine;immunomodulation, prophylactic use;mutagenicity

Journal Article;Review

Giri, Allan;Das, Ankita;Sarkar, Ajoy K;Giri, Ashok K

10.1186/s41021-020-00164-0

[Title]: Mutagenic, Genotoxic and Immunomodulatory effects of Hydroxychloroquine and Chloroquine: a review to evaluate its potential to use as a prophylactic drug against COVID-19. [Abstract]: Hydroxychloroquine (HCQ) and Chloroquine (CQ) are two anti-malarial drugs that are now being extensively used by front-line healthcare workers and other common people as a prophylactic drug against the Corona Virus Disease - 19 (COVID-19) in India and as well as in many parts of the world. While only a few in vitro studies have pointed to some efficacy of these drugs as a prophylactic against COVID-19, to date, there are no clinical studies that have established any clinical efficacy of these drugs as a prophylactic. These drugs are commonly used for the treatment of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) because of its immunomodulatory effects. Previously, we have evaluated the genetic toxicology of different drugs and chemicals including antimalarial drug CQ both in vitro and in vivo. Thus, we recognize the need to critically review the mutagenic, genotoxic, and immunomodulatory effects of these drugs, to find out whether it is safe to use as a prophylactic drug against COVID-19. Existing literature suggests that CQ can induce mutagenic and genotoxic effects in multiple test systems and both the drugs have immunomodulatory effects. There was no data available to evaluate the mutagenicity and genotoxicity for HCQ. However, during metabolism about 60% of both the drugs remain unchanged and about 40% of the drugs are metabolized into two metabolites, desethylchloroquine and bisdesethylchloroquine by the action of the cytochrome P450 (CYP) enzymes in the liver. Both HCQ and CQ are immunomodulatory drugs and have the potential to suppress normal immune system activation. In this review, we have elucidated the mechanism of immunomodulation by both HCQ and CQ and highlighted the mutagenic and genotoxic effects from the available literature. This article is written with the sole objective that the reader will be able to recognize the adverse effects of these drugs when consumed by healthy individuals as a prophylactic. Current literature indicates that healthy individuals should refrain from the use of these drugs until further investigation. [Keywords]: covid-19;chloroquine;genotoxicity;hydroxychloroquine;immunomodulation, prophylactic use;mutagenicity

Int J Surg

Avoiding health worker infection and containing the coronavirus disease 2019 pandemic: Perspectives from the frontline in Wuhan.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused great public concern worldwide due to its high rates of infectivity and pathogenicity. The Chinese government responded in a timely manner, alleviated the dilemma, achieved a huge victory and lockdown has now been lifted in Wuhan. However, the outbreak has occurred in more than 200 other countries. Globally, as of 9:56 am CEST on 19 May 2020, there have been 4,696,849 confirmed cases of COVID-19, including 315,131 deaths, reported to Word Health Organization (WHO). The spread of COVID-19 overwhelmed the healthcare systems of many countries and even crashed the fragile healthcare systems of some. Although the situation in each country is different, health workers play a critical role in the fight against COVID-19. In this review, we highlight the status of health worker infections in China and other countries, especially the causes of infection in China and the standardised protocol to protect health workers from the perspective of an anaesthesiologist, in the hope of providing references to reduce medical infections and contain the COVID-19 epidemic.

asymptomatic infection;covid-19;health worker infection;personal protective equipment;sars-cov-2

Journal Article;Review

Tang, Ling-Hua;Tang, Shan;Chen, Xiao-Liang;Zhang, Shi;Xiong, Yong;Chen, Rong;Li, Wei;Liu, Hui-Min;Xia, Zhong-Yuan;Meng, Qing-Tao

10.1016/j.ijsu.2020.05.060

[Title]: Avoiding health worker infection and containing the coronavirus disease 2019 pandemic: Perspectives from the frontline in Wuhan. [Abstract]: Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused great public concern worldwide due to its high rates of infectivity and pathogenicity. The Chinese government responded in a timely manner, alleviated the dilemma, achieved a huge victory and lockdown has now been lifted in Wuhan. However, the outbreak has occurred in more than 200 other countries. Globally, as of 9:56 am CEST on 19 May 2020, there have been 4,696,849 confirmed cases of COVID-19, including 315,131 deaths, reported to Word Health Organization (WHO). The spread of COVID-19 overwhelmed the healthcare systems of many countries and even crashed the fragile healthcare systems of some. Although the situation in each country is different, health workers play a critical role in the fight against COVID-19. In this review, we highlight the status of health worker infections in China and other countries, especially the causes of infection in China and the standardised protocol to protect health workers from the perspective of an anaesthesiologist, in the hope of providing references to reduce medical infections and contain the COVID-19 epidemic. [Keywords]: asymptomatic infection;covid-19;health worker infection;personal protective equipment;sars-cov-2

Front Public Health

Comparison of Epidemiological Variations in COVID-19 Patients Inside and Outside of China-A Meta-Analysis.

The objective of this study is to compare the epidemiological variations in COVID-19 patients reported in studies from inside and outside of China. We selected COVID-19 observational studies from eight countries, including, China, Italy, Australia, Canada, Korea, Taiwan, Singapore, and the USA, comprising a total of 13 studies and performed a meta-analysis for age, gender, fatality rate, and clinical symptoms of fever, cough, shortness of breath, and diarrhea. The meta-analysis shows that there are differences in symptoms and other characteristics reported by the patients of COVID-19 inside and outside China. Patients in China have a higher proportion of fever, cough, and shortness of breath as compared to patients outside of China. However, we found the opposite results for the gastrointestinal symptoms such as Diarrhea. Patients outside of China have a significantly higher proportion of Diarrhea as compared to patients within China. We also observed gender disparity among our studies, with the male population being more susceptible than the female population. Moreover, the analysis suggests that the fatality rate in China is relatively lower as compared to the fatality rate in other countries. These findings also suggest that the clinical symptoms of COVID-19 should not be generalized to fever, shortness of breath, and cough only but other symptoms such as diarrhea are also prevalent in patients with COVID-19.

2019-ncov;covid-19;epidemiological characteristics;meta-analysis;symptoms

Journal Article;Meta-Analysis;Systematic Review

Ahmed, Ali;Ali, Areeba;Hasan, Sana

10.3389/fpubh.2020.00193

[Title]: Comparison of Epidemiological Variations in COVID-19 Patients Inside and Outside of China-A Meta-Analysis. [Abstract]: The objective of this study is to compare the epidemiological variations in COVID-19 patients reported in studies from inside and outside of China. We selected COVID-19 observational studies from eight countries, including, China, Italy, Australia, Canada, Korea, Taiwan, Singapore, and the USA, comprising a total of 13 studies and performed a meta-analysis for age, gender, fatality rate, and clinical symptoms of fever, cough, shortness of breath, and diarrhea. The meta-analysis shows that there are differences in symptoms and other characteristics reported by the patients of COVID-19 inside and outside China. Patients in China have a higher proportion of fever, cough, and shortness of breath as compared to patients outside of China. However, we found the opposite results for the gastrointestinal symptoms such as Diarrhea. Patients outside of China have a significantly higher proportion of Diarrhea as compared to patients within China. We also observed gender disparity among our studies, with the male population being more susceptible than the female population. Moreover, the analysis suggests that the fatality rate in China is relatively lower as compared to the fatality rate in other countries. These findings also suggest that the clinical symptoms of COVID-19 should not be generalized to fever, shortness of breath, and cough only but other symptoms such as diarrhea are also prevalent in patients with COVID-19. [Keywords]: 2019-ncov;covid-19;epidemiological characteristics;meta-analysis;symptoms

Am J Ophthalmol

Implications of Coronavirus Disease 2019 for Ophthalmologists.

PURPOSE: To describe and explain the implications of coronavirus disease 2019 (COVID-19) for ophthalmologists considering the rapid developments in our understanding of the virology, transmission, and ocular involvement. DESIGN: Evidence-based perspective. METHODS: Review and synthesis of pertinent literature. RESULTS: Retrospective studies highlight that <1% of patients display COVID-19-related conjunctivitis. However, prospective studies suggest the rate is higher (~6%). Viral RNA has been identified in tears and conjunctival secretions in patients with active conjunctivitis as well as asymptomatic cases. Overall, conjunctival swabs are positive in 2.5%. Samples taken earlier in the disease course are more likely to demonstrate positive virus. Viral transmission through ocular tissues has not been substantiated. Ophthalmologists are in the high-risk category for COVID-19 infection for several reasons: high-volume clinics, close proximity with patients, equipment-intense clinics, and direct contact with patients' conjunctival mucosal surfaces. COVID-19 is predominantly contracted through direct or airborne transmission by inhalation of respiratory droplets. Evidence that aerosol transmission occurs is increasing in particularly prolonged exposure to high concentrations in a relatively closed environment. Based on the current evidence, ophthalmologists should consider measures that include social distancing, wearing masks, sterilization techniques, and managing clinic volumes. CONCLUSIONS: A major challenge to containing COVID-19 is that many infected people are asymptomatic. Droplet spread, contaminated environmental surfaces, and shared medical devices are areas that require management by ophthalmologists. More studies are required to explore the role of the conjunctiva and ocular tissues in the transmission of disease.

Journal Article

Danesh-Meyer, Helen V;McGhee, Charles N J

10.1016/j.ajo.2020.09.027

[Title]: Implications of Coronavirus Disease 2019 for Ophthalmologists. [Abstract]: PURPOSE: To describe and explain the implications of coronavirus disease 2019 (COVID-19) for ophthalmologists considering the rapid developments in our understanding of the virology, transmission, and ocular involvement. DESIGN: Evidence-based perspective. METHODS: Review and synthesis of pertinent literature. RESULTS: Retrospective studies highlight that <1% of patients display COVID-19-related conjunctivitis. However, prospective studies suggest the rate is higher (~6%). Viral RNA has been identified in tears and conjunctival secretions in patients with active conjunctivitis as well as asymptomatic cases. Overall, conjunctival swabs are positive in 2.5%. Samples taken earlier in the disease course are more likely to demonstrate positive virus. Viral transmission through ocular tissues has not been substantiated. Ophthalmologists are in the high-risk category for COVID-19 infection for several reasons: high-volume clinics, close proximity with patients, equipment-intense clinics, and direct contact with patients' conjunctival mucosal surfaces. COVID-19 is predominantly contracted through direct or airborne transmission by inhalation of respiratory droplets. Evidence that aerosol transmission occurs is increasing in particularly prolonged exposure to high concentrations in a relatively closed environment. Based on the current evidence, ophthalmologists should consider measures that include social distancing, wearing masks, sterilization techniques, and managing clinic volumes. CONCLUSIONS: A major challenge to containing COVID-19 is that many infected people are asymptomatic. Droplet spread, contaminated environmental surfaces, and shared medical devices are areas that require management by ophthalmologists. More studies are required to explore the role of the conjunctiva and ocular tissues in the transmission of disease. [Keywords]:

PLoS One

Before and after case reporting: A comparison of the knowledge, attitude and practices of the Jordanian population towards COVID-19.

Coronavirus disease- 2019 (COVID-19) is an emerging contagious infectious disease. It is pandemic and has affected more than 21 million people and resulted in more than 750,000 deaths worldwide (https://www.worldometers.info/coronavirus/#countries; 14/08/20). Our research group initiated a study to ascertain the knowledge, attitude and practices (KAP) of Jordanians toward COVID-19 prior to any initial case report in Jordan. This project was underway when the first Jordanian case was reported. We extended our study to identify how case reporting would alter public KAP towards COVID-19. This cross-sectional study randomly selected and recruited 2104 Jordanian adults. A four-section questionnaire was devised to address the sociodemographic characteristics of the subjects and their KAP toward COVID-19. The mean knowledge score for the study population was 15.9 +/- 2.2 (out of the 20 knowledge questions), with 60.9% of the participants having good knowledge about COVID-19. Participants' practices to prevent transmission of COVID-19 were adequate in more than 60% of participants. Most participants had positive attitudes regarding their role in preventing COVID-19 and many of the participants' attitudes and practices changed to more appropriate ones after reporting the first case of COVID-19 in Jordan. The percentage of participants who trust the government in confronting COVID-19 increased significantly (p value < 0.001). However, one alarming and unexpected finding was that the prevention practice score of participants working in the medical field was similar to those from the general population. This may necessitate stricter training and guidelines for this group who will be in the frontline in combating the disease. Impact of this study: The data generated from this study shows that when cases of disease were reported, the public's attitudes and practices improved in many aspects, and that confidence in the government to contain the disease was boosted. We believe that this study is important in allowing other, international governments to develop an understanding of public KAP during pandemic disease outbreaks.

Journal Article

Elayeh, Eman;Aleidi, Shereen M;Ya'acoub, Rawan;Haddadin, Randa N

10.1371/journal.pone.0240780

[Title]: Before and after case reporting: A comparison of the knowledge, attitude and practices of the Jordanian population towards COVID-19. [Abstract]: Coronavirus disease- 2019 (COVID-19) is an emerging contagious infectious disease. It is pandemic and has affected more than 21 million people and resulted in more than 750,000 deaths worldwide (https://www.worldometers.info/coronavirus/#countries; 14/08/20). Our research group initiated a study to ascertain the knowledge, attitude and practices (KAP) of Jordanians toward COVID-19 prior to any initial case report in Jordan. This project was underway when the first Jordanian case was reported. We extended our study to identify how case reporting would alter public KAP towards COVID-19. This cross-sectional study randomly selected and recruited 2104 Jordanian adults. A four-section questionnaire was devised to address the sociodemographic characteristics of the subjects and their KAP toward COVID-19. The mean knowledge score for the study population was 15.9 +/- 2.2 (out of the 20 knowledge questions), with 60.9% of the participants having good knowledge about COVID-19. Participants' practices to prevent transmission of COVID-19 were adequate in more than 60% of participants. Most participants had positive attitudes regarding their role in preventing COVID-19 and many of the participants' attitudes and practices changed to more appropriate ones after reporting the first case of COVID-19 in Jordan. The percentage of participants who trust the government in confronting COVID-19 increased significantly (p value < 0.001). However, one alarming and unexpected finding was that the prevention practice score of participants working in the medical field was similar to those from the general population. This may necessitate stricter training and guidelines for this group who will be in the frontline in combating the disease. Impact of this study: The data generated from this study shows that when cases of disease were reported, the public's attitudes and practices improved in many aspects, and that confidence in the government to contain the disease was boosted. We believe that this study is important in allowing other, international governments to develop an understanding of public KAP during pandemic disease outbreaks. [Keywords]:

Trials

Efficacy of local budesonide therapy in the management of persistent hyposmia in COVID-19 patients without signs of severity: A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: To assess the efficacy of local intranasal treatment with budesonide (nasal irrigation), in addition to olfactory rehabilitation, in the management of loss of smell in COVID-19 patients without signs of severity and with persistent hyposmia 30 days after the onset of symptoms. To search for an association between the presence of an obstruction on MRI and the severity of olfactory loss, at inclusion and after 30 days of treatment. TRIAL DESIGN: Two center, open-label, 2-arm (1:1 ratio) parallel group randomized controlled superiority trial. PARTICIPANTS: Inclusion criteria - Patient over 18 years of age; - Patient with a suspected SARS-CoV-2 infection, whether or not confirmed by PCR, or close contact with a PCR-confirmed case, typical chest CT scan (unsystematic frosted glass patches with predominantly sub-pleural appearance, and at a later stage, alveolar condensation without excavation or nodules or masses) or positive serology ; - Patient with isolated sudden onset hyposmia persisting 30 days after the onset of symptoms of CoV-2 SARS infection; - Affiliate or beneficiary of a social security scheme; - Written consent to participate in the study. Non-inclusion criteria - Known hypersensitivity to budesonide or any of the excipients; - Hemostasis disorder or epistaxis; - Oral-nasal and ophthalmic herpes virus infection; - Long-term corticosteroid treatment; - Treatment with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV protease inhibitors); - Severe forms of SARS-CoV-2 with respiratory or other signs; - Hyposmia persisting for more than 90 days after the onset of symptoms - Other causes of hyposmia found on interrogation or MRI; - Patient benefiting from a legal protection measure; - Pregnant or breastfeeding women. The participants will be recruited from: Hopital Fondation Adolphe de Rothschild and Hopital Lariboisiere in Paris, France INTERVENTION AND COMPARATOR: Intervention: Experimental group: Nasal irrigation with budesonide and physiological saline (Budesonide 1mg/2mL diluted in 250mL of physiological saline 9 degrees /00): 3 syringes of 20mL in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. CONTROL GROUP: Nasal irrigation with physiological saline 9 degrees /00 only: 3 syringes of 20cc in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. MAIN OUTCOMES: Percentage of patients with an improvement of more than 2 points on the ODORATEST score after 30 days of treatment. RANDOMISATION: Patients will be randomized (1:1) between the experimental and control groups, using the e-CRF. The randomization list will be stratified by centre. BLINDING (MASKING): Participants and caregivers are aware of the group assignment. People assessing the outcomes are blinded to the group assignment Numbers to be randomised (sample size) 120 patients are planned to be randomized into two groups of 60 patients. TRIAL STATUS: MDL_2020_10. Version number 2, May 22, 2020. Recruitment started on May 22, 2020. The trial will finish recruiting by August 2020. TRIAL REGISTRATION: EUDRACT number: 2020-001667-85; date of trial registration: 15 May 2020 Protocol registered on ClinicalTrial.gov, registration number: NCT04361474 ; date of trial registration: 24 April 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

covid-19;mri;randomised controlled trial;budesonide;corticosteroid;dysgeusia;hyposmia;nasal irrigation;rotocol

Clinical Trial Protocol;Letter;Multicenter Study

Daval, Mary;Corre, Alain;Palpacuer, Clement;Housset, Juliette;Poillon, Guillaume;Eliezer, Michael;Verillaud, Benjamin;Slama, Dorsaf;Ayache, Denis;Herman, Philippe;Jourdaine, Clement;Herve, Camille;El Bakkouri, Wissame;Salmon, Dominique;Hautefort, Charlotte

10.1186/s13063-020-04585-8

[Title]: Efficacy of local budesonide therapy in the management of persistent hyposmia in COVID-19 patients without signs of severity: A structured summary of a study protocol for a randomised controlled trial. [Abstract]: OBJECTIVES: To assess the efficacy of local intranasal treatment with budesonide (nasal irrigation), in addition to olfactory rehabilitation, in the management of loss of smell in COVID-19 patients without signs of severity and with persistent hyposmia 30 days after the onset of symptoms. To search for an association between the presence of an obstruction on MRI and the severity of olfactory loss, at inclusion and after 30 days of treatment. TRIAL DESIGN: Two center, open-label, 2-arm (1:1 ratio) parallel group randomized controlled superiority trial. PARTICIPANTS: Inclusion criteria - Patient over 18 years of age; - Patient with a suspected SARS-CoV-2 infection, whether or not confirmed by PCR, or close contact with a PCR-confirmed case, typical chest CT scan (unsystematic frosted glass patches with predominantly sub-pleural appearance, and at a later stage, alveolar condensation without excavation or nodules or masses) or positive serology ; - Patient with isolated sudden onset hyposmia persisting 30 days after the onset of symptoms of CoV-2 SARS infection; - Affiliate or beneficiary of a social security scheme; - Written consent to participate in the study. Non-inclusion criteria - Known hypersensitivity to budesonide or any of the excipients; - Hemostasis disorder or epistaxis; - Oral-nasal and ophthalmic herpes virus infection; - Long-term corticosteroid treatment; - Treatment with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV protease inhibitors); - Severe forms of SARS-CoV-2 with respiratory or other signs; - Hyposmia persisting for more than 90 days after the onset of symptoms - Other causes of hyposmia found on interrogation or MRI; - Patient benefiting from a legal protection measure; - Pregnant or breastfeeding women. The participants will be recruited from: Hopital Fondation Adolphe de Rothschild and Hopital Lariboisiere in Paris, France INTERVENTION AND COMPARATOR: Intervention: Experimental group: Nasal irrigation with budesonide and physiological saline (Budesonide 1mg/2mL diluted in 250mL of physiological saline 9 degrees /00): 3 syringes of 20mL in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. CONTROL GROUP: Nasal irrigation with physiological saline 9 degrees /00 only: 3 syringes of 20cc in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. MAIN OUTCOMES: Percentage of patients with an improvement of more than 2 points on the ODORATEST score after 30 days of treatment. RANDOMISATION: Patients will be randomized (1:1) between the experimental and control groups, using the e-CRF. The randomization list will be stratified by centre. BLINDING (MASKING): Participants and caregivers are aware of the group assignment. People assessing the outcomes are blinded to the group assignment Numbers to be randomised (sample size) 120 patients are planned to be randomized into two groups of 60 patients. TRIAL STATUS: MDL_2020_10. Version number 2, May 22, 2020. Recruitment started on May 22, 2020. The trial will finish recruiting by August 2020. TRIAL REGISTRATION: EUDRACT number: 2020-001667-85; date of trial registration: 15 May 2020 Protocol registered on ClinicalTrial.gov, registration number: NCT04361474 ; date of trial registration: 24 April 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. [Keywords]: covid-19;mri;randomised controlled trial;budesonide;corticosteroid;dysgeusia;hyposmia;nasal irrigation;rotocol

Int Immunopharmacol

Recent findings on the Coronavirus disease 2019 (COVID-19); immunopathogenesis and immunotherapeutics.

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) is responsible for recent ongoing public health emergency in the world. Sharing structural and behavioral similarities with its ancestors [SARS and Middle East Respiratory Syndrome (MERS)], SARS-CoV-2 has lower fatality but faster transmission. We have gone through a long path to recognize SARS and MERS, therefore our knowledge regarding SARS-CoV-2 is not raw. Various responses of the immune system account for the wide spectrum of clinical manifestations in Coronavirus disease-2019 (COVID-19). Given the innate immune response as the front line of defense, it is immediately activated after the virus entry. Consequently, adaptive immune response is activated to eradicate the virus. However, this does not occur in every case and immune response is the main culprit causing the pathological manifestations of COVID-19. Lethal forms of the disease are correlated with inefficient and/or insufficient immune responses associated with cytokine storm. Current therapeutic approach for COVID-19 is in favor of suppressing extreme inflammatory responses, while maintaining the immune system alert and responsive against the virus. This could be contributing along with administration of antiviral drugs in such patients. Furthermore, supplementation with different compounds, such as vitamin D, has been tested to modulate the immune system responses. A thorough understanding of chronological events in COVID-19 contributing to the development of a highly efficient treatment has not figured out yet. This review focuses on the virus-immune system interaction as well as currently available and potential therapeutic approaches targeting immune system in the treatment of COVID-19 patients.

coronavirus disease-2019;immune system;immunotherapeutics;severe acute respiratory syndrome coronavirus-2;treatment

Journal Article;Review

Ebrahimi, Negin;Aslani, Saeed;Babaie, Farhad;Hemmatzadeh, Maryam;Hosseinzadeh, Ramin;Joneidi, Zeinab;Mehdizadeh Tourzani, Zahra;Pakravan, Nafiseh;Mohammadi, Hamed

10.1016/j.intimp.2020.107082

[Title]: Recent findings on the Coronavirus disease 2019 (COVID-19); immunopathogenesis and immunotherapeutics. [Abstract]: Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) is responsible for recent ongoing public health emergency in the world. Sharing structural and behavioral similarities with its ancestors [SARS and Middle East Respiratory Syndrome (MERS)], SARS-CoV-2 has lower fatality but faster transmission. We have gone through a long path to recognize SARS and MERS, therefore our knowledge regarding SARS-CoV-2 is not raw. Various responses of the immune system account for the wide spectrum of clinical manifestations in Coronavirus disease-2019 (COVID-19). Given the innate immune response as the front line of defense, it is immediately activated after the virus entry. Consequently, adaptive immune response is activated to eradicate the virus. However, this does not occur in every case and immune response is the main culprit causing the pathological manifestations of COVID-19. Lethal forms of the disease are correlated with inefficient and/or insufficient immune responses associated with cytokine storm. Current therapeutic approach for COVID-19 is in favor of suppressing extreme inflammatory responses, while maintaining the immune system alert and responsive against the virus. This could be contributing along with administration of antiviral drugs in such patients. Furthermore, supplementation with different compounds, such as vitamin D, has been tested to modulate the immune system responses. A thorough understanding of chronological events in COVID-19 contributing to the development of a highly efficient treatment has not figured out yet. This review focuses on the virus-immune system interaction as well as currently available and potential therapeutic approaches targeting immune system in the treatment of COVID-19 patients. [Keywords]: coronavirus disease-2019;immune system;immunotherapeutics;severe acute respiratory syndrome coronavirus-2;treatment

Med Hypotheses

Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly?

Geriatric patients seem to be the most vulnerable group in COVID-19. These patients are usually characterized by impaired mobilization and malnutrition. In addition, obesity has been correlated with increased mortality rates after COVID-19 infection, highlighting the role of nutrition in prognosis of COVID-19 as well. In the past, several indices of nutritional status (GNRI) and functional status (ECOG performance status, Barthel Index, Handgrip Strength) have demonstrated a prognostic ability for hospitalized patients with influenza-like respiratory infections from coronavirus, metapneumovirus, parainfluenza and rhinovirus. Our hypothesis suggests that the previously mentioned nutritional and functional status indices, combined with the pneumonia severity index (CRB-65), could be useful in prognosis of morbidity and mortality of the elderly after the novel COVID-19 infection. Our hypothesis, is the first in the literature, which suggests a prognostic association between nutritional status of patients and COVID-19 infection, offering a quick and low-cost prognostic tool for COVID-19 in the elderly.

covid-19;elderly;frailty;functional status;malnutrition

Journal Article

Lidoriki, Irene;Frountzas, Maximos;Schizas, Dimitrios

10.1016/j.mehy.2020.109946

[Title]: Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? [Abstract]: Geriatric patients seem to be the most vulnerable group in COVID-19. These patients are usually characterized by impaired mobilization and malnutrition. In addition, obesity has been correlated with increased mortality rates after COVID-19 infection, highlighting the role of nutrition in prognosis of COVID-19 as well. In the past, several indices of nutritional status (GNRI) and functional status (ECOG performance status, Barthel Index, Handgrip Strength) have demonstrated a prognostic ability for hospitalized patients with influenza-like respiratory infections from coronavirus, metapneumovirus, parainfluenza and rhinovirus. Our hypothesis suggests that the previously mentioned nutritional and functional status indices, combined with the pneumonia severity index (CRB-65), could be useful in prognosis of morbidity and mortality of the elderly after the novel COVID-19 infection. Our hypothesis, is the first in the literature, which suggests a prognostic association between nutritional status of patients and COVID-19 infection, offering a quick and low-cost prognostic tool for COVID-19 in the elderly. [Keywords]: covid-19;elderly;frailty;functional status;malnutrition

J Public Health (Oxf)

The substantial awareness role of web-based and social media platforms in developing countries during a pandemic scenario: the example of COVID-19.

BACKGROUND: During the outbreak of coronavirus COVID-19, social media platforms have shown effectiveness in information dissemination. Delivering evidence-based medical knowledge and trustworthy recommendations is a difficult mission for classical entities, especially in a war-torn country with a fragile health system. In this context, the role of non-governmental scientific organizations was proven, filling the gap between original scientific sources and a non-English speaking population. METHODS: We reviewed an example of an organization named Syrian Researchers, which publishes based-on-reliable-sources of scientific content and has massive reachability across Middle East and beyond. RESULTS: We strongly believe that this model is a simple and suitable approach that may be helpful for other low-income or war-torn countries in the context of health-related disasters. CONCLUSIONS: This subject is of high importance and we believe that this approach may ameliorate public health knowledge, thus, participate in defying the COVID-19 consequences.

Letter

Abdul-Baki, Mohammad-Nasan;Dhemesh, Yaseen;Alasadi, Lugien;Alsuliman, Tamim

10.1093/pubmed/fdaa075

[Title]: The substantial awareness role of web-based and social media platforms in developing countries during a pandemic scenario: the example of COVID-19. [Abstract]: BACKGROUND: During the outbreak of coronavirus COVID-19, social media platforms have shown effectiveness in information dissemination. Delivering evidence-based medical knowledge and trustworthy recommendations is a difficult mission for classical entities, especially in a war-torn country with a fragile health system. In this context, the role of non-governmental scientific organizations was proven, filling the gap between original scientific sources and a non-English speaking population. METHODS: We reviewed an example of an organization named Syrian Researchers, which publishes based-on-reliable-sources of scientific content and has massive reachability across Middle East and beyond. RESULTS: We strongly believe that this model is a simple and suitable approach that may be helpful for other low-income or war-torn countries in the context of health-related disasters. CONCLUSIONS: This subject is of high importance and we believe that this approach may ameliorate public health knowledge, thus, participate in defying the COVID-19 consequences. [Keywords]:

Cureus

First Case of an Infant with COVID-19 in the Middle East.

The novel coronavirus (COVID-19) has been declared a worldwide pandemic. It was initially thought to spare children and adolescents as significantly smaller number of cases have been reported in the pediatric population in comparison to adults. Here, we report the case of a 16-month-old female infant from Lebanon who presented with fever and severe diarrhea and tested positive for COVID-19. Her symptoms started six days prior to presentation with no cough, rhinorrhea, or other respiratory manifestations reported. Chest radiography showed lobar consolidation and bronchial infiltrates. Blood culture was positive for Streptococcus pneumoniae. Stool and urine cultures were negative. She was treated with ceftriaxone and metronidazole. Her RT-PCR test was negative after five days of treatment, suggesting that children can clear the virus faster than adults. The patient likely contracted the virus from her parents, who because of the fear of social stigma hide recent history of respiratory illness. These findings serve as a practical reference for the clinical diagnosis and medical treatment of children with COVID-19.

children;coronavirus;covid-19;gastrointestinal symptoms;infants;lebanon;middle east;pandemic;pediatrics;sars-cov-2

Case Reports

Mansour, Amani;Atoui, Rola;Kanso, Kamal;Mohsen, Rami;Fares, Youssef;Fares, Jawad

10.7759/cureus.7520

[Title]: First Case of an Infant with COVID-19 in the Middle East. [Abstract]: The novel coronavirus (COVID-19) has been declared a worldwide pandemic. It was initially thought to spare children and adolescents as significantly smaller number of cases have been reported in the pediatric population in comparison to adults. Here, we report the case of a 16-month-old female infant from Lebanon who presented with fever and severe diarrhea and tested positive for COVID-19. Her symptoms started six days prior to presentation with no cough, rhinorrhea, or other respiratory manifestations reported. Chest radiography showed lobar consolidation and bronchial infiltrates. Blood culture was positive for Streptococcus pneumoniae. Stool and urine cultures were negative. She was treated with ceftriaxone and metronidazole. Her RT-PCR test was negative after five days of treatment, suggesting that children can clear the virus faster than adults. The patient likely contracted the virus from her parents, who because of the fear of social stigma hide recent history of respiratory illness. These findings serve as a practical reference for the clinical diagnosis and medical treatment of children with COVID-19. [Keywords]: children;coronavirus;covid-19;gastrointestinal symptoms;infants;lebanon;middle east;pandemic;pediatrics;sars-cov-2

Can J Respir Ther

Helmet CPAP revisited in COVID-19 pneumonia: A case series.

Introduction: Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients. Case and outcomes: This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease. Discussion: NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population. Conclusion: Helmet NIPPV is a feasible therapy to manage COVID-19 patients.

bipap;covid19;cpap; bilevel positive airway pressure;nippv;niv helmet;sars-cov2;continuous positive airway pressure;non-invasive positive pressure ventilation

Case Reports

Rali, Aniket S;Howard, Christopher;Miller, Rachel;Morgan, Christopher K;Mejia, Dennis;Sabo, John;Herlihy, James P;Devarajan, Sunjay R

10.29390/cjrt-2020-019

[Title]: Helmet CPAP revisited in COVID-19 pneumonia: A case series. [Abstract]: Introduction: Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients. Case and outcomes: This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease. Discussion: NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population. Conclusion: Helmet NIPPV is a feasible therapy to manage COVID-19 patients. [Keywords]: bipap;covid19;cpap; bilevel positive airway pressure;nippv;niv helmet;sars-cov2;continuous positive airway pressure;non-invasive positive pressure ventilation

Int J Med Sci

A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells.

The outbreak of pneumonia caused by SARS-CoV-2 posed a great threat to global human health, which urgently requires us to understand comprehensively the mechanism of SARS-CoV-2 infection. Angiotensin-converting enzyme 2 (ACE2) was identified as a functional receptor for SARS-CoV-2, distribution of which may indicate the risk of different human organs vulnerable to SARS-CoV-2 infection. Previous studies investigating the distribution of ACE2 mRNA in human tissues only involved a limited size of the samples and a lack of determination for ACE2 protein. Given the heterogeneity among humans, the datasets covering more tissues with a larger size of samples should be analyzed. Indeed, ACE2 is a membrane and secreted protein, while the expression of ACE2 in blood and common blood cells remains unknown. Herein, the proteomic data in HIPED and the antibody-based immunochemistry result in HPA were collected to analyze the distribution of ACE2 protein in human tissues. The bulk RNA-seq profiles from three separate public datasets including HPA tissue Atlas, GTEx, and FANTOM5 CAGE were also obtained to determine the expression of ACE2 in human tissues. Moreover, the abundance of ACE2 in human blood and blood cells was determined by analyzing the data in the PeptideAtlas and the HPA Blood Atlas. We found that the mRNA expression cannot reflect the abundance of ACE2 factor due to the strong differences between mRNA and protein quantities of ACE2 within and across tissues. Our results suggested that ACE2 protein is mainly expressed in the small intestine, kidney, gallbladder, and testis, while the abundance of which in brain-associated tissues and blood common cells is low. HIPED revealed enrichment of ACE2 protein in the placenta and ovary despite a low mRNA level. Further, human secretome shows that the average concentration of ACE2 protein in the plasma of males is higher than those in females. Our research will be beneficial for understanding the transmission routes and sex-based differences in susceptibility of SARS-CoV-2 infection.

angiotensin-converting enzyme 2;blood cells;human tissues;sars-cov-2

Journal Article

Wang, Yiliang;Wang, Yun;Luo, Weisheng;Huang, Lianzhou;Xiao, Ji;Li, Feng;Qin, Shurong;Song, Xiaowei;Wu, Yanting;Zeng, Qiongzhen;Jin, Fujun;Wang, Yifei

10.7150/ijms.46695

[Title]: A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells. [Abstract]: The outbreak of pneumonia caused by SARS-CoV-2 posed a great threat to global human health, which urgently requires us to understand comprehensively the mechanism of SARS-CoV-2 infection. Angiotensin-converting enzyme 2 (ACE2) was identified as a functional receptor for SARS-CoV-2, distribution of which may indicate the risk of different human organs vulnerable to SARS-CoV-2 infection. Previous studies investigating the distribution of ACE2 mRNA in human tissues only involved a limited size of the samples and a lack of determination for ACE2 protein. Given the heterogeneity among humans, the datasets covering more tissues with a larger size of samples should be analyzed. Indeed, ACE2 is a membrane and secreted protein, while the expression of ACE2 in blood and common blood cells remains unknown. Herein, the proteomic data in HIPED and the antibody-based immunochemistry result in HPA were collected to analyze the distribution of ACE2 protein in human tissues. The bulk RNA-seq profiles from three separate public datasets including HPA tissue Atlas, GTEx, and FANTOM5 CAGE were also obtained to determine the expression of ACE2 in human tissues. Moreover, the abundance of ACE2 in human blood and blood cells was determined by analyzing the data in the PeptideAtlas and the HPA Blood Atlas. We found that the mRNA expression cannot reflect the abundance of ACE2 factor due to the strong differences between mRNA and protein quantities of ACE2 within and across tissues. Our results suggested that ACE2 protein is mainly expressed in the small intestine, kidney, gallbladder, and testis, while the abundance of which in brain-associated tissues and blood common cells is low. HIPED revealed enrichment of ACE2 protein in the placenta and ovary despite a low mRNA level. Further, human secretome shows that the average concentration of ACE2 protein in the plasma of males is higher than those in females. Our research will be beneficial for understanding the transmission routes and sex-based differences in susceptibility of SARS-CoV-2 infection. [Keywords]: angiotensin-converting enzyme 2;blood cells;human tissues;sars-cov-2

Disaster Med Public Health Prep

Mexico and the COVID-19 Response.

Mexico has been one of the most affected countries in the world by the COVID-19 pandemic. The true impact of the pandemic has probably been underestimated, and President Lopez Obrador, as well as the Ministry of Health, has struggled to lead the country since the beginning. While cases and deaths continue to rise, stronger leadership and unity are needed to limit the impact of COVID-19 on the health of millions of Mexicans.

covid-19;mexico;coronavirus;leadership;pandemics;public health response;sentinel surveillance

Letter

Ibarra-Nava, Ismael;Cardenas-de la Garza, Jesus A;Ruiz-Lozano, Raul E;Salazar-Montalvo, Raul G

10.1017/dmp.2020.260

[Title]: Mexico and the COVID-19 Response. [Abstract]: Mexico has been one of the most affected countries in the world by the COVID-19 pandemic. The true impact of the pandemic has probably been underestimated, and President Lopez Obrador, as well as the Ministry of Health, has struggled to lead the country since the beginning. While cases and deaths continue to rise, stronger leadership and unity are needed to limit the impact of COVID-19 on the health of millions of Mexicans. [Keywords]: covid-19;mexico;coronavirus;leadership;pandemics;public health response;sentinel surveillance

Cureus

Managing Acute Portal Hypertensive Gastropathy Bleed During the Time of COVID-19 Pandemic: Novelty or Necessity?

Acute bleeding from portal hypertensive gastropathy (PHG) is an extremely rare event in the natural history of cirrhosis. The treatment recommendations include portal pressure reduction strategies including pharmacotherapy with vasoactive agents and beta-blockers and interventional strategies such as transjugular intrahepatic portosystemic shunt placement. In this report, we present the case of a patient with cirrhosis in whom acute PHG-related bleed was managed with endoscopic band ligation, a therapeutic modality which has not been described in current literature. Our decision to re-purpose a technique for variceal bleeding stems from the fact that during the ongoing COVID-19 pandemic, the technical assistance, resource availability, and sourcing of materials that were required for us to follow recommended management guidelines for acute PHG-related bleed was severely affected due to imposed lockdown between districts and states.

banding;cirrhosis;coronavirus;covid;endoscopy;evl;gi bleeding;phg

Case Reports

Philips, Cyriac A;Kumbar, Sandeep;Ahamed, Rizwan;Augustine, Philip

10.7759/cureus.8333

[Title]: Managing Acute Portal Hypertensive Gastropathy Bleed During the Time of COVID-19 Pandemic: Novelty or Necessity? [Abstract]: Acute bleeding from portal hypertensive gastropathy (PHG) is an extremely rare event in the natural history of cirrhosis. The treatment recommendations include portal pressure reduction strategies including pharmacotherapy with vasoactive agents and beta-blockers and interventional strategies such as transjugular intrahepatic portosystemic shunt placement. In this report, we present the case of a patient with cirrhosis in whom acute PHG-related bleed was managed with endoscopic band ligation, a therapeutic modality which has not been described in current literature. Our decision to re-purpose a technique for variceal bleeding stems from the fact that during the ongoing COVID-19 pandemic, the technical assistance, resource availability, and sourcing of materials that were required for us to follow recommended management guidelines for acute PHG-related bleed was severely affected due to imposed lockdown between districts and states. [Keywords]: banding;cirrhosis;coronavirus;covid;endoscopy;evl;gi bleeding;phg

Trop Med Infect Dis

Prognosis of COVID-19 in Patients with Liver and Kidney Diseases: An Early Systematic Review and Meta-Analysis.

The mortality and severity in COVID-19 is increased in patients with comorbidities. The aim of this study was to evaluate the severity and mortality in COVID-19 patients with underlying kidney and liver diseases. We retrieved data on the clinical features and primary composite end point of COVID-19 patients from Medline and Embase which had been released from inception by the April 16, 2020. The data on two comorbidities, liver diseases and chronic kidney disease, were pooled and statistically analysed to explain the associated severity and mortality rate. One hundred and forty-two abstracts were screened, and 41 full articles were then read. In total, 22 studies including 5595 COVID-19 patients were included in this study with case fatality rate of 16%. The prevalence of liver diseases and chronic kidney disease (CKD) were 3% (95% CI; 2-3%) and 1% (95% CI; 1-2%), respectively. In patients with COVID-19 and underlying liver diseases, 57.33% (43/75) of cases were severe, with 17.65% mortality, while in CKD patients, 83.93% (47/56) of cases were severe and 53.33% (8/15) mortality was reported. This study found an increased risk of severity and mortality in COVID-19 patients with liver diseases or CKD. This will lead to better clinical management and inform the process of implementing more stringent preventative measures for this group of patients.

covid-19;sars-cov-2;alcohol-related liver disease;chronic kidney disease;cirrhosis;hepatitis b and c;necrosis;nonalcoholic steatohepatitis

Journal Article;Review

Oyelade, Tope;Alqahtani, Jaber;Canciani, Gabriele

10.3390/tropicalmed5020080

[Title]: Prognosis of COVID-19 in Patients with Liver and Kidney Diseases: An Early Systematic Review and Meta-Analysis. [Abstract]: The mortality and severity in COVID-19 is increased in patients with comorbidities. The aim of this study was to evaluate the severity and mortality in COVID-19 patients with underlying kidney and liver diseases. We retrieved data on the clinical features and primary composite end point of COVID-19 patients from Medline and Embase which had been released from inception by the April 16, 2020. The data on two comorbidities, liver diseases and chronic kidney disease, were pooled and statistically analysed to explain the associated severity and mortality rate. One hundred and forty-two abstracts were screened, and 41 full articles were then read. In total, 22 studies including 5595 COVID-19 patients were included in this study with case fatality rate of 16%. The prevalence of liver diseases and chronic kidney disease (CKD) were 3% (95% CI; 2-3%) and 1% (95% CI; 1-2%), respectively. In patients with COVID-19 and underlying liver diseases, 57.33% (43/75) of cases were severe, with 17.65% mortality, while in CKD patients, 83.93% (47/56) of cases were severe and 53.33% (8/15) mortality was reported. This study found an increased risk of severity and mortality in COVID-19 patients with liver diseases or CKD. This will lead to better clinical management and inform the process of implementing more stringent preventative measures for this group of patients. [Keywords]: covid-19;sars-cov-2;alcohol-related liver disease;chronic kidney disease;cirrhosis;hepatitis b and c;necrosis;nonalcoholic steatohepatitis

Pharmacotherapy

Delayed Initiation of Remdesivir in a COVID-19-Positive Patient.

We present a case of late initiation of remdesivir antiviral therapy in the successful treatment of a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a mixed medical intensive care unit of a community teaching hospital. A previously healthy 40-year-old man was admitted to the hospital 3 days after the onset of coronavirus disease 2019 (COVID-19) symptoms including dry cough, fever, and shortness of breath progressing to intubation and increased mechanical ventilator support. A request for compassionate use remdesivir was submitted on the same hospital day as the positive COVID-19 polymerase chain reaction result. Supportive measures, in addition to a 5-day course of hydroxychloroquine, were maintained until remdesivir could be supplied on day 9 of hospitalization, 13 days after symptom onset. Sixty hours after initiating remdesivir, the patient was successfully extubated and able to transition to room air within 24 hours of extubation. Late initiation of remdesivir may be effective in treating SARS-CoV-2, unlike antivirals utilized for different disease states, such as oseltamivir, that are most effective when started as soon as possible following symptom onset. Urgent action is needed by regulatory agencies to work with drug manufacturers to expedite the study and approval of investigational agents targeting SARS-CoV-2 as well as to meet manufacturing demands.

covid-19;sars-cov-2;coronavirus;pneumonia;remdesivir;viral pneumonia

Case Reports

Hillaker, Emily;Belfer, Julie J;Bondici, Anamaria;Murad, Hani;Dumkow, Lisa E

10.1002/phar.2403

[Title]: Delayed Initiation of Remdesivir in a COVID-19-Positive Patient. [Abstract]: We present a case of late initiation of remdesivir antiviral therapy in the successful treatment of a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a mixed medical intensive care unit of a community teaching hospital. A previously healthy 40-year-old man was admitted to the hospital 3 days after the onset of coronavirus disease 2019 (COVID-19) symptoms including dry cough, fever, and shortness of breath progressing to intubation and increased mechanical ventilator support. A request for compassionate use remdesivir was submitted on the same hospital day as the positive COVID-19 polymerase chain reaction result. Supportive measures, in addition to a 5-day course of hydroxychloroquine, were maintained until remdesivir could be supplied on day 9 of hospitalization, 13 days after symptom onset. Sixty hours after initiating remdesivir, the patient was successfully extubated and able to transition to room air within 24 hours of extubation. Late initiation of remdesivir may be effective in treating SARS-CoV-2, unlike antivirals utilized for different disease states, such as oseltamivir, that are most effective when started as soon as possible following symptom onset. Urgent action is needed by regulatory agencies to work with drug manufacturers to expedite the study and approval of investigational agents targeting SARS-CoV-2 as well as to meet manufacturing demands. [Keywords]: covid-19;sars-cov-2;coronavirus;pneumonia;remdesivir;viral pneumonia

J Biol Chem

Sphingosine prevents binding of SARS-CoV-2 spike to its cellular receptor ACE2.

Sphingosine has been shown to prevent and eliminate bacterial infections of the respiratory tract, but it is unknown whether sphingosine can be also employed to prevent viral infections. To test this hypothesis, we analyzed whether sphingosine regulates the infection of cultured and freshly isolated ex vivo human epithelial cells with pseudoviral particles expressing SARS-CoV-2 spike (pp-VSV-SARS-CoV-2 spike) that served as a bona fide system mimicking SARS-CoV-2 infection. We demonstrate that exogenously applied sphingosine suspended in 0.9% NaCl prevents cellular infection with pp-SARS-CoV-2 spike. Pretreatment of cultured Vero epithelial cells or freshly isolated human nasal epithelial cells with low concentrations of sphingosine prevented adhesion of and infection with pp-VSV-SARS-CoV-2 spike. Mechanistically, we demonstrate that sphingosine binds to ACE2, the cellular receptor of SARS-CoV-2, and prevents the interaction of the receptor-binding domain of the viral spike protein with ACE2. These data indicate that sphingosine prevents at least some viral infections by interfering with the interaction of the virus with its receptor. Our data also suggest that further preclinical and finally clinical examination of sphingosine is warranted for potential use as a prophylactic or early treatment for coronavirus disease-19.

ace2;sars-cov-2;epithelium;human nasal epithelial cells;infection;infectious disease;nasal epithelial cells;receptor;sphingolipid;sphingosine;spike;virus entry

Journal Article;Research Support, Non-U.S. Gov't

Edwards, Michael J;Becker, Katrin Anne;Gripp, Barbara;Hoffmann, Markus;Keitsch, Simone;Wilker, Barbara;Soddemann, Matthias;Gulbins, Anne;Carpinteiro, Elisa;Patel, Sameer H;Wilson, Gregory C;Pohlmann, Stefan;Walter, Silke;Fassbender, Klaus;Ahmad, Syed A;Carpinteiro, Alexander;Gulbins, Erich

10.1074/jbc.RA120.015249

[Title]: Sphingosine prevents binding of SARS-CoV-2 spike to its cellular receptor ACE2. [Abstract]: Sphingosine has been shown to prevent and eliminate bacterial infections of the respiratory tract, but it is unknown whether sphingosine can be also employed to prevent viral infections. To test this hypothesis, we analyzed whether sphingosine regulates the infection of cultured and freshly isolated ex vivo human epithelial cells with pseudoviral particles expressing SARS-CoV-2 spike (pp-VSV-SARS-CoV-2 spike) that served as a bona fide system mimicking SARS-CoV-2 infection. We demonstrate that exogenously applied sphingosine suspended in 0.9% NaCl prevents cellular infection with pp-SARS-CoV-2 spike. Pretreatment of cultured Vero epithelial cells or freshly isolated human nasal epithelial cells with low concentrations of sphingosine prevented adhesion of and infection with pp-VSV-SARS-CoV-2 spike. Mechanistically, we demonstrate that sphingosine binds to ACE2, the cellular receptor of SARS-CoV-2, and prevents the interaction of the receptor-binding domain of the viral spike protein with ACE2. These data indicate that sphingosine prevents at least some viral infections by interfering with the interaction of the virus with its receptor. Our data also suggest that further preclinical and finally clinical examination of sphingosine is warranted for potential use as a prophylactic or early treatment for coronavirus disease-19. [Keywords]: ace2;sars-cov-2;epithelium;human nasal epithelial cells;infection;infectious disease;nasal epithelial cells;receptor;sphingolipid;sphingosine;spike;virus entry

Disaster Med Public Health Prep

Public Health Lessons Learned From Biases in Coronavirus Mortality Overestimation.

In testimony before US Congress on March 11, 2020, members of the House Oversight and Reform Committee were informed that estimated mortality for the novel coronavirus was 10-times higher than for seasonal influenza. Additional evidence, however, suggests the validity of this estimation could benefit from vetting for biases and miscalculations. The main objective of this article is to critically appraise the coronavirus mortality estimation presented to Congress. Informational texts from the World Health Organization and the Centers for Disease Control and Prevention are compared with coronavirus mortality calculations in Congressional testimony. Results of this critical appraisal reveal information bias and selection bias in coronavirus mortality overestimation, most likely caused by misclassifying an influenza infection fatality rate as a case fatality rate. Public health lessons learned for future infectious disease pandemics include: safeguarding against research biases that may underestimate or overestimate an associated risk of disease and mortality; reassessing the ethics of fear-based public health campaigns; and providing full public disclosure of adverse effects from severe mitigation measures to contain viral transmission.

covid-19;case fatality rate;coronavirus mortality overestimation;infection fatality rate;sampling bias

Journal Article

Brown, Ronald B

10.1017/dmp.2020.298

[Title]: Public Health Lessons Learned From Biases in Coronavirus Mortality Overestimation. [Abstract]: In testimony before US Congress on March 11, 2020, members of the House Oversight and Reform Committee were informed that estimated mortality for the novel coronavirus was 10-times higher than for seasonal influenza. Additional evidence, however, suggests the validity of this estimation could benefit from vetting for biases and miscalculations. The main objective of this article is to critically appraise the coronavirus mortality estimation presented to Congress. Informational texts from the World Health Organization and the Centers for Disease Control and Prevention are compared with coronavirus mortality calculations in Congressional testimony. Results of this critical appraisal reveal information bias and selection bias in coronavirus mortality overestimation, most likely caused by misclassifying an influenza infection fatality rate as a case fatality rate. Public health lessons learned for future infectious disease pandemics include: safeguarding against research biases that may underestimate or overestimate an associated risk of disease and mortality; reassessing the ethics of fear-based public health campaigns; and providing full public disclosure of adverse effects from severe mitigation measures to contain viral transmission. [Keywords]: covid-19;case fatality rate;coronavirus mortality overestimation;infection fatality rate;sampling bias

Carbohydr Polym

A review on chitosan and its development as pulmonary particulate anti-infective and anti-cancer drug carriers.

Chitosan, as a biodegradable and biocompatible polymer, is characterized by anti-microbial and anti-cancer properties. It lately has received a widespread interest for use as the pulmonary particulate backbone materials of drug carrier for the treatment of infectious disease and cancer. The success of chitosan as pulmonary particulate drug carrier is a critical interplay of their mucoadhesive, permeation enhancement and site/cell-specific attributes. In the case of nanocarriers, various microencapsulation and micro-nano blending systems have been devised to equip them with an appropriate aerodynamic character to enable efficient pulmonary aerosolization and inhalation. The late COVID-19 infection is met with acute respiratory distress syndrome and cancer. Chitosan and its derivatives are found useful in combating HCoV and cancer as a function of their molecular weight, substituent type and its degree of substitution. The interest in chitosan is expected to rise in the next decade from the perspectives of drug delivery in combination with its therapeutic performance.

cancer;chitosan;infection;nanoparticle;pulmonary drug delivery

Journal Article;Review

Rasul, Ruhisy Mohd;Tamilarasi Muniandy, M;Zakaria, Zabliza;Shah, Kifayatullah;Chee, Chin Fei;Dabbagh, Ali;Rahman, Noorsaadah Abd;Wong, Tin Wui

10.1016/j.carbpol.2020.116800

[Title]: A review on chitosan and its development as pulmonary particulate anti-infective and anti-cancer drug carriers. [Abstract]: Chitosan, as a biodegradable and biocompatible polymer, is characterized by anti-microbial and anti-cancer properties. It lately has received a widespread interest for use as the pulmonary particulate backbone materials of drug carrier for the treatment of infectious disease and cancer. The success of chitosan as pulmonary particulate drug carrier is a critical interplay of their mucoadhesive, permeation enhancement and site/cell-specific attributes. In the case of nanocarriers, various microencapsulation and micro-nano blending systems have been devised to equip them with an appropriate aerodynamic character to enable efficient pulmonary aerosolization and inhalation. The late COVID-19 infection is met with acute respiratory distress syndrome and cancer. Chitosan and its derivatives are found useful in combating HCoV and cancer as a function of their molecular weight, substituent type and its degree of substitution. The interest in chitosan is expected to rise in the next decade from the perspectives of drug delivery in combination with its therapeutic performance. [Keywords]: cancer;chitosan;infection;nanoparticle;pulmonary drug delivery

Monaldi Arch Chest Dis

Cardiovascular system and COVID-19: perspectives from a developing country.

A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the "heart and virus" link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients.

Journal Article;Review

Kunal, Shekhar;Gupta, Kashish;Sharma, Shashi Mohan;Pathak, Vijay;Mittal, Shruti;Tarke, Chandrakant

10.4081/monaldi.2020.1305

[Title]: Cardiovascular system and COVID-19: perspectives from a developing country. [Abstract]: A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the "heart and virus" link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients. [Keywords]:

Nature

Structural basis of receptor recognition by SARS-CoV-2.

A novel severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2) recently emerged and is rapidly spreading in humans, causing COVID-19(1,2). A key to tackling this pandemic is to understand the receptor recognition mechanism of the virus, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor-angiotensin-converting enzyme 2 (ACE2)-in humans(3,4). Here we determined the crystal structure of the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 (engineered to facilitate crystallization) in complex with ACE2. In comparison with the SARS-CoV RBD, an ACE2-binding ridge in SARS-CoV-2 RBD has a more compact conformation; moreover, several residue changes in the SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD-ACE2 interface. These structural features of SARS-CoV-2 RBD increase its ACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus that is closely related to SARS-CoV-2, also uses human ACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV and RaTG13 in ACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies that target receptor recognition by SARS-CoV-2.

Comparative Study;Journal Article;Research Support, N.I.H., Extramural;Research Support, U.S. Gov't, Non-P.H.S.

Shang, Jian;Ye, Gang;Shi, Ke;Wan, Yushun;Luo, Chuming;Aihara, Hideki;Geng, Qibin;Auerbach, Ashley;Li, Fang

10.1038/s41586-020-2179-y

[Title]: Structural basis of receptor recognition by SARS-CoV-2. [Abstract]: A novel severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2) recently emerged and is rapidly spreading in humans, causing COVID-19(1,2). A key to tackling this pandemic is to understand the receptor recognition mechanism of the virus, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor-angiotensin-converting enzyme 2 (ACE2)-in humans(3,4). Here we determined the crystal structure of the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 (engineered to facilitate crystallization) in complex with ACE2. In comparison with the SARS-CoV RBD, an ACE2-binding ridge in SARS-CoV-2 RBD has a more compact conformation; moreover, several residue changes in the SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD-ACE2 interface. These structural features of SARS-CoV-2 RBD increase its ACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus that is closely related to SARS-CoV-2, also uses human ACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV and RaTG13 in ACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies that target receptor recognition by SARS-CoV-2. [Keywords]:

Aging Clin Exp Res

COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants.

BACKGROUND: Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. AIMS: We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. METHODS: 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK during 2006-10. A modified assessment of frailty using Fried's classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. RESULTS: 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (>/= 4 comorbidity groupings vs 0-1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. DISCUSSION AND CONCLUSIONS: Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.

covid-19;epidemiology;frailty;musculoskeletal;osteoporosis;uk biobank

Journal Article

Woolford, S J;D'Angelo, S;Curtis, E M;Parsons, C M;Ward, K A;Dennison, E M;Patel, H P;Cooper, C;Harvey, N C

10.1007/s40520-020-01653-6

[Title]: COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants. [Abstract]: BACKGROUND: Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. AIMS: We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. METHODS: 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK during 2006-10. A modified assessment of frailty using Fried's classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. RESULTS: 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (>/= 4 comorbidity groupings vs 0-1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. DISCUSSION AND CONCLUSIONS: Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed. [Keywords]: covid-19;epidemiology;frailty;musculoskeletal;osteoporosis;uk biobank

Child Abuse Negl

Brazilian Child Protection Professionals' Resilient Behavior during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic deeply affected child protection professionals. One potential area of concern is whether and how the pandemic has dampened these individuals' ability to engage in the resilient practices that are so vital to their wellbeing. OBJECTIVE: Within the unique and understudied context of a developing economy facing the strain of an international pandemic, this study sought to expand our theoretical understanding of the individual and socio-ecological predictors of whether child protective services professionals engage in resilient behaviors. PARTICIPANTS AND SETTING: Three hundred and nine professionals working in child protection related fields (e.g., psychologists, social workers, professors, pediatricians, nurses, and other clinicians). METHODS: Participants were surveyed as to their demographics, current work conditions, their engagement in resilient behaviors, and potential individual and socio-ecological predictors of those behaviors. RESULTS: Both job support for and individuals' beliefs of the importance of resilient behaviors predicted their engagement in such behaviors. CONCLUSIONS: Child protection professionals' resilience must be fostered by socio-ecological contexts, such as their workplace and employers, and additional supports are needed during the trying times of the COVID-19 pandemic.

covid-19;child maltreatment;child protection;psychological resilience

Journal Article

Priolo Filho, Sidnei R;Goldfarb, Deborah;Zibetti, Murilo R;Aznar-Blefari, Carlos

10.1016/j.chiabu.2020.104701

[Title]: Brazilian Child Protection Professionals' Resilient Behavior during the COVID-19 Pandemic. [Abstract]: BACKGROUND: The COVID-19 pandemic deeply affected child protection professionals. One potential area of concern is whether and how the pandemic has dampened these individuals' ability to engage in the resilient practices that are so vital to their wellbeing. OBJECTIVE: Within the unique and understudied context of a developing economy facing the strain of an international pandemic, this study sought to expand our theoretical understanding of the individual and socio-ecological predictors of whether child protective services professionals engage in resilient behaviors. PARTICIPANTS AND SETTING: Three hundred and nine professionals working in child protection related fields (e.g., psychologists, social workers, professors, pediatricians, nurses, and other clinicians). METHODS: Participants were surveyed as to their demographics, current work conditions, their engagement in resilient behaviors, and potential individual and socio-ecological predictors of those behaviors. RESULTS: Both job support for and individuals' beliefs of the importance of resilient behaviors predicted their engagement in such behaviors. CONCLUSIONS: Child protection professionals' resilience must be fostered by socio-ecological contexts, such as their workplace and employers, and additional supports are needed during the trying times of the COVID-19 pandemic. [Keywords]: covid-19;child maltreatment;child protection;psychological resilience